Non-AF Stroke Heart Syndrome, Left Atrial Volume Index, and AF Detected After Stroke

Left atrial volume index (LAVI) and the presence of non-atrial fibrillation stroke heart syndrome features are independently associated with atrial fibrillation detected after stroke (AFDAS), according to a study in the Journal of Stroke and Cerebrovascular Diseases.

Investigators retrospectively analyzed adult patients with acute ischemic stroke and transient ischemic attack who presented within 4.5 hours to a center from January 2013 to August 2018.

AFDAS was defined as the presence of AF or atrial flutter according to electrocardiogram or 30-day event monitor within 90 days of the index stroke. The study authors developed separate multivariable logistic regression models to determine whether non-AF stroke heart syndrome features were independently associated with AFDAS.

A total of 988 patients were included: no AF (n=574; aged median 68 years; 43.9% women); known AF (n=311; aged median 82 years; 55.3% women); and AFDAS (n=103; aged median 77 years; 49.5% women).

Of the full cohort, 26.7% of patients fulfilled the criteria for stroke heart syndrome, 17.6% of whom had non-AF stroke heart syndrome (67 participants without AF; 66 participants with known AF; 41 participants with AFDAS).

Among the 677 patients without known AF, non-AF stroke heart syndrome was associated with a 5-fold odds of AFDAS (odds ratio [OR], 5.004; 95% CI, 3.129-8.004; P <.001).

Overall, 61.5% of patients with non-AF stroke heart syndrome features had AFDAS or known AF, and 37.7% of those without non-AF stroke heart syndrome had AFDAS or known AF (P <.001). A differential association was observed regarding non-AF stroke heart syndrome features with AF status (P <.001).

AFDAS was associated with an increased occurrence of non-AF stroke heart syndrome (P <.001), older age (P <.001), greater admission National Institutes of Health Stroke Scale score (P <.001), greater CHA₂DS₂-VASc score (P =.004), systemic thrombolysis (P =.001), and history of hypertension (P =.005).

Multivariable logistic regression analysis showed that non-AF stroke heart syndrome was independently associated with AFDAS after adjustment for relevant clinical patient characteristics (n=677; model 2, OR 4.4; 95% CI, 2.64-7.29; P <.001). After additional adjustment for cardiac markers (n=453; model 3) only non-AF stroke heart syndrome (OR 3.24; 95% CI, 1.23-8.56; P =.018) and LAVI (OR, 1.04; 95% CI, 1.01-1.08; P =.004) were independently associated with AFDAS.

Study limitations include the single-center, retrospective design. In addition, the researchers did not obtain information on medical management, such as antiarrhythmic agents, which could have affected the findings. Furthermore, it is possible that the association between stroke heart syndrome features and AFDAS may reflect selection bias, and not all patients completed long-term cardiac monitoring.

“Most important, after adjustment of our multivariable models for important clinical covariates, markers of stroke severity and extent, and cardiac markers, we found that the presence of non-AF [stroke heart syndrome] features remained independently associated with AFDAS,” the study authors wrote. “This observation provides proof-of-principle that the presence of non-AF [stroke heart syndrome] features represents a risk factor for AFDAS; though not conclusive, this suggests that neurogenic cardiac injury is an important underlying mechanism of AFDAS associated with non-AF [stroke heart syndrome] features.”

Reference

Sun Y, Miller MM, Yaghi S, Henninger N. Association of atrial fibrillation detected after stroke with cardiac dysfunction and features of neurogenic cardiac injury. J Stroke Cerebrovasc Dis. Published online March 24, 2022. doi: 10.1016/j.jstrokecerebrovasdis.2022.106445