Measuring Left Atrial Mechanical Function Can Improve Stroke Prediction

I see nothing here that is useful. Predicting stroke does nothing if you don't have protocols that will prevent it from happening. DO YOU PEOPLE EVER THINK AT ALL?

Measuring Left Atrial Mechanical Function Can Improve Stroke Prediction

A cohort study of more than 4,500 persons without a history of atrial fibrillation (AF) or stroke has found that measuring left atrial mechanical function can improve stroke prediction.

“In people without prior atrial fibrillation or stroke, when added to CHA2DS2-VASc variables, left atrial reservoir strain improves

stroke prediction and yields a predicted net benefit, as shown by decision curve analysis,” wrote Ankit Maheshwari, MD, Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, and colleagues.

The study, published in Annals of Internal Medicine, included 4,917 participants without a history of stroke or AF from the Atherosclerosis Risk in Communities (ARIC) study. The researchers evaluated the association of echocardiographic left atrial function (reservoir, conduit, and contractile strain) and left atrial size (left atrial volume index) with ischaemic stroke. Ischemic stroke events (2011-2019) were adjudicated by physicians. Left atrial strain was measured using speckle-tracking echocardiography.

Over 5 years, the cumulative incidences of ischaemic stroke in the lowest quintiles of left atrial reservoir, conduit, and contractile strain were 2.99%, 3.18%, and 2.15%, respectively, and that of severe left atrial enlargement was 1.99%.

“On the basis of the Akaike information criterion, left atrial reservoir strain plus CHA2DS2-VASc variables was the best predictive model,” the authors wrote. “With the addition of left atrial reservoir strain to CHA2DS2-VASc variables, 11.6% of the 112 participants with stroke after 5 years were reclassified to higher risk categories and 1.8% to lower risk categories. Among the 4805 participants who did not develop stroke, 12.2% were reclassified to lower and 12.7% to higher risk categories.”

In an accompanying editorial, Darae Ko, MD, and Emelia J. Benjamin, MD, Boston Medical Center, Boston, Massachusetts, applaud the study authors for bringing attention to the possible role of atrial cardiopathy in mediating cardioembolic stroke in the absence of AF. They also said the findings of the study are important in the real-world setting.

Reference: https://www.acpjournals.org/doi/10.7326/M22-1638

SOURCE: American College of Physicians