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Atrial Strain as a Biomarker of Atrial Fibrillation in Cryptogenic Stroke: A Survival Analysis of 538 Patients
Abstracts
diastolic dysfunction (DD). There were 21 studies included in the analysis which showed a significant correlation with increasing EAT and presence of DD, mean e’ and E/e’ but not E/A ratio, independent of adiposity measures. There was a greater EAT in patients with DD, WMD 24.43 mL (95%CI 18.530.4, p < 0.001) and meta-regression confirmed the association of increasing EAT with DD (Figure). A significant association was identified between EAT and increasing left ventricular mass, however the reported independence of this effect from other adiposity measures was inconsistent. EAT appeared to correlate inversely with left ventricular ejection fraction (LVEF), however the association with LVEF or other systolic parameters was not independent of other variables.
Conclusions: There is a signal of an association between EAT and diastolic function as well as chamber size but not systolic function. Prospective and rigorous study is necessary to confirm this association and evaluate changes resultant from intervention. http://dx.doi.org/10.1016/j.hlc.2017.06.467 467 Asymptomatic Cardiac Mass–Thrombosed Aneurysm of a Coronary Fistula F. Lee 1,∗ , S. Ung 1 , J. Scadden 3 , M. Preiato 3 , A. Abraham 1,2,3 1 Royal
Perth Hospital, Perth, Australia Stanley Hospital, Perth, Australia 3 Imaging Central, Perth, Australia 2 Fiona
A 33-year-old female was noted to have a systolic murmur during anaesthetic review prior to surgery for ectopic pregnancy. Transthoracic echocardiography suggested an encapsulated immobile spherical right atrial mass suspicious of myxoma. Left ventricular systolic function and valvular structures were normal. Low dose cardiac computed tomography (CT) revealed a large (57 × 23 × 26 mm) mass in the epicardial tissue plane with focal calcification, superposterior to the right atrium, posterior to the aorta and superior vena cava, inferior to the right pulmonary artery and anterior to the left atrium. The largest calibre branch of the dilated left main was a dilated branch of the proximal circumflex which supplied the mass, suspected to be a thrombosed aneurysm of coronary-cameral fistula. This was confirmed on cardiac MRI angiography. The coronary arteries were otherwise normal. Cardiac MRI performed subsequently confirmed CT findings and further demonstrated low to intermediate signal intensity with some heterogeneity within the body of the mass with no definite fat and absence of first pass or delayed perfusion. There was no delayed enhancement. Diagnosis was changed to thrombosed aneurysm of a coronary fistula.
S247
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Given increased thromboembolic risk, coronary angiography to assess drainage of the mass will be arranged. This case illustrates the incremental value of cardiac CT and cardiac MRI compared to echocardiography in identifying cardiac masses and elucidating their relationship to surrounding structures. http://dx.doi.org/10.1016/j.hlc.2017.06.468 468 Atrial Strain as a Biomarker of Atrial Fibrillation in Cryptogenic Stroke: A Survival Analysis of 538 Patients F. Pathan 1,2,∗ , E. Sivaraj 4 , R. Rafiudeen 4 , S. Pathan 5 , J. Galligan 1 , K. Negishi 1,4 , T. Marwick 1,3 1 The
Menzies Institute for Medical Research, Hobart, Australia 2 Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt, Germany 3 Baker Heart and Diabetes Institute, Melbourne, Australia 4 Royal Hobart Hospital, Hobart, Australia 5 Nepean Hospital, Sydney, Australia Background: Cryptogenic sources account for 30-40% of Ischaemic cerebrovascular accidents (CVAs). Atrial fibrillation (AF) is found in up to 30% of cryptogenic CVAs. Atrial strain can be used as an imaging biomarker to predict AF. Methods: We performed a retrospective observational study evaluating all patients who had a cryptogenic CVA between 2010- 2014. Patients were followed for up to 5 years. The echocardiograms (TTE) were evaluated for Reservoir (R), Contractile (Ct) and Conduit strain (Cd) using speckle tracking. Baseline clinical and TTE characteristics were compared between AF and non AF populations and used as input functions for a Classification and Regression Tree Analysis (CART). Results: A total of 538 patients were included, 11.3% went on to develop AF. Patients who developed AF were older, had higher prevalence of hypertension and heart failure. CHARGE-AF and CHA2 DS2 -VASc scores were higher in the AF group. LA volume was higher in patients who developed AF. Atrial strain was lower in those who developed AF: R 21vs33, Cd 12vs17, and Ct 10vs15 (all p < 0.001). All other variables were similar. R and Ct improved AUC for the CHARGE-AF model from 0.78 to 0.88, p < 0.001. CART identified (Charge AF and R/Ct as discriminatory nodes with a sensitivity and specificity of 90% and 70% for AF), positive patients had a HR of 13:1 [95%CI 9-17] for development of AF on multivariate analysis. Conclusion: Atrial strain improves current AF risk prediction scores and a composite score can be used as a sensitive predictor of AF following cryptogenic CVAs. http://dx.doi.org/10.1016/j.hlc.2017.06.469
diastolic dysfunction (DD). There were 21 studies included in the analysis which showed a significant correlation with increasing EAT and presence of DD, mean e’ and E/e’ but not E/A ratio, independent of adiposity measures. There was a greater EAT in patients with DD, WMD 24.43 mL (95%CI 18.530.4, p < 0.001) and meta-regression confirmed the association of increasing EAT with DD (Figure). A significant association was identified between EAT and increasing left ventricular mass, however the reported independence of this effect from other adiposity measures was inconsistent. EAT appeared to correlate inversely with left ventricular ejection fraction (LVEF), however the association with LVEF or other systolic parameters was not independent of other variables.
Conclusions: There is a signal of an association between EAT and diastolic function as well as chamber size but not systolic function. Prospective and rigorous study is necessary to confirm this association and evaluate changes resultant from intervention. http://dx.doi.org/10.1016/j.hlc.2017.06.467 467 Asymptomatic Cardiac Mass–Thrombosed Aneurysm of a Coronary Fistula F. Lee 1,∗ , S. Ung 1 , J. Scadden 3 , M. Preiato 3 , A. Abraham 1,2,3 1 Royal
Perth Hospital, Perth, Australia Stanley Hospital, Perth, Australia 3 Imaging Central, Perth, Australia 2 Fiona
A 33-year-old female was noted to have a systolic murmur during anaesthetic review prior to surgery for ectopic pregnancy. Transthoracic echocardiography suggested an encapsulated immobile spherical right atrial mass suspicious of myxoma. Left ventricular systolic function and valvular structures were normal. Low dose cardiac computed tomography (CT) revealed a large (57 × 23 × 26 mm) mass in the epicardial tissue plane with focal calcification, superposterior to the right atrium, posterior to the aorta and superior vena cava, inferior to the right pulmonary artery and anterior to the left atrium. The largest calibre branch of the dilated left main was a dilated branch of the proximal circumflex which supplied the mass, suspected to be a thrombosed aneurysm of coronary-cameral fistula. This was confirmed on cardiac MRI angiography. The coronary arteries were otherwise normal. Cardiac MRI performed subsequently confirmed CT findings and further demonstrated low to intermediate signal intensity with some heterogeneity within the body of the mass with no definite fat and absence of first pass or delayed perfusion. There was no delayed enhancement. Diagnosis was changed to thrombosed aneurysm of a coronary fistula.
S247
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
Given increased thromboembolic risk, coronary angiography to assess drainage of the mass will be arranged. This case illustrates the incremental value of cardiac CT and cardiac MRI compared to echocardiography in identifying cardiac masses and elucidating their relationship to surrounding structures. http://dx.doi.org/10.1016/j.hlc.2017.06.468 468 Atrial Strain as a Biomarker of Atrial Fibrillation in Cryptogenic Stroke: A Survival Analysis of 538 Patients F. Pathan 1,2,∗ , E. Sivaraj 4 , R. Rafiudeen 4 , S. Pathan 5 , J. Galligan 1 , K. Negishi 1,4 , T. Marwick 1,3 1 The
Menzies Institute for Medical Research, Hobart, Australia 2 Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt, Germany 3 Baker Heart and Diabetes Institute, Melbourne, Australia 4 Royal Hobart Hospital, Hobart, Australia 5 Nepean Hospital, Sydney, Australia Background: Cryptogenic sources account for 30-40% of Ischaemic cerebrovascular accidents (CVAs). Atrial fibrillation (AF) is found in up to 30% of cryptogenic CVAs. Atrial strain can be used as an imaging biomarker to predict AF. Methods: We performed a retrospective observational study evaluating all patients who had a cryptogenic CVA between 2010- 2014. Patients were followed for up to 5 years. The echocardiograms (TTE) were evaluated for Reservoir (R), Contractile (Ct) and Conduit strain (Cd) using speckle tracking. Baseline clinical and TTE characteristics were compared between AF and non AF populations and used as input functions for a Classification and Regression Tree Analysis (CART). Results: A total of 538 patients were included, 11.3% went on to develop AF. Patients who developed AF were older, had higher prevalence of hypertension and heart failure. CHARGE-AF and CHA2 DS2 -VASc scores were higher in the AF group. LA volume was higher in patients who developed AF. Atrial strain was lower in those who developed AF: R 21vs33, Cd 12vs17, and Ct 10vs15 (all p < 0.001). All other variables were similar. R and Ct improved AUC for the CHARGE-AF model from 0.78 to 0.88, p < 0.001. CART identified (Charge AF and R/Ct as discriminatory nodes with a sensitivity and specificity of 90% and 70% for AF), positive patients had a HR of 13:1 [95%CI 9-17] for development of AF on multivariate analysis. Conclusion: Atrial strain improves current AF risk prediction scores and a composite score can be used as a sensitive predictor of AF following cryptogenic CVAs. http://dx.doi.org/10.1016/j.hlc.2017.06.469