Atrial premature activity detected after an ischaemic stroke unveils atrial myopathy
Résumé
BACKGROUND: Recent publications suggest that left atrial (LA) myopathy is a potential source of thromboembolism, independent of atrial fibrillation. AIMS: We sought to investigate whether the presence of atrial premature activity after an ischaemic stroke is associated with LA remodelling and dysfunction, and might be a surrogate marker of LA myopathy. METHODS: After an ischaemic stroke or a transient ischaemic attack, patients without known atrial fibrillation or overt heart disease were included prospectively in the study. All patients had a standard workup, including ambulatory Holter electrocardiogram monitoring and transthoracic echocardiography. In some patients, transoesophageal echocardiography was also performed. Anatomical and functional LA remodelling were assessed using minimal and maximal volumes and LA emptying fraction in two-dimensional and three-dimensional echocardiography. Patients were separated into two groups according to the burden of atrial premature complexes (APCs), measured by Holter electrocardiography. RESULTS: Among 148 eligible patients recruited from October 2015 to May 2016, 93 were included in the group with non-frequent APCs (nf-APC:\textless100 APCs/24hours) and 43 in the group with frequent APCs (f-APC:\textgreater100 APCs/24hours). Twelve patients had paroxysmal atrial fibrillation, and were not included in the statistical analysis. Maximal and minimal indexed LA volumes were significantly higher in the f-APC group than in the nf-APC group (P\textless0.01). LA emptying fraction was worse in the f-APC group than in the nf-APC group. In addition, LA appendage emptying velocity was impaired in the f-APC group, and was correlated with LA remodelling variables, especially LA emptying fraction (r=0.621). CONCLUSIONS: After an ischaemic stroke or a transient ischaemic attack, excessive APCs are associated with LA remodelling. Thus, LA dilatation and dysfunction reflect early LA myopathy, which might itself be responsible for cardioembolic stroke.
Mots clés
Female
Humans
Male
Middle Aged
Risk Factors
Aged
Prospective Studies
80 and over
Risk Assessment
Echocardiography
Transesophageal
Three-Dimensional
Atrial myopathy
Atrial premature activity
Cardioembolic stroke
Dysfonction atriale gauche
Extrasystole auriculaire
Left atrial dysfunction
Left atrial remodelling
Myopathie atriale
*Atrial Function
Left
*Atrial Remodeling
Accident vasculaire cérébral cardioembolique
Atrial Premature Complexes/*complications/diagnosis/physiopathology
Brain Ischemia/diagnosis/*etiology
Electrocardiography
Ambulatory
Ischemic Attack
Transient/diagnosis/*etiology
Remodelage de l’oreillette gauche
Stroke/diagnosis/*etiology
Domaines
Sciences du Vivant [q-bio]
Origine : Fichiers produits par l'(les) auteur(s)