Abstract 4142338: Atrial mechanical remodeling could be predictable for newly developed atrial fibrillation in patients with embolic stroke with undetermined source

Background: Atrial fibrillation (AF) has been known as a main cause of embolic stroke. Well-chosen candidate to be anticoagulated should be critical for secondary prevention in patients with embolic stroke with undetermined source (ESUS). Atrial mechanical remodeling presenting cardiomyopathy could lead to not only occur atrial fibrillation but also increase risk of thromboembolism. Objective: To investigate association of LA strain, and newly detected AF in patients with ESUS. Methods: A total of 45 patients diagnosed ESUS with implantable loop recorder (ILR) who were prospectively enrolled and clinically followed for newly developed AF for secondary prevention in the 3 referral centers. Transthoracic echocardiography including LA strain analysis were performed. Results: 11 patients (24%) among all (mean age 67 years, 58% male) have developed newly AF and others have maintained sinus rhythm within 2 years. The mean age, proportion of hypertension and diabetes were similar between sinus rhythm and newly AF patients. LA diameter (36.3 ± 6.6 mm vs. 39.3 ± 6.0 mm) and E of E’ (11.0 ± 4.5 mm vs. 9.2 ± 1.1 mm) were also similar between two group. Even though peak and pump LA strain in the newly AF were lower than those in sinus rhythm without statistically significance (24.7 ± 6.4 vs. 22.3 ± 8.8 and 10.8 ± 3.8 vs. 9.2 ± 4.9). Pump LA strain (cut-off value9.1) was significantly associated with developing newly AF during follow-up (hazard ratio=4.8, 1.27-18.3, p=0.02) Conclusion: Our data demonstrated that the pump LA strain was significantly associated with developing newly AF in the ESUS. This result suggests that atrial mechanical remodeling could be predictable for newly developed AF in patients with ESUS