Cardiac imaging correlates and predictors of stroke in patients with atrial fibrillation: a meta-analysis

Jean Jacques Noubiap, Ulrich Flore Nyaga, Melissa E. Middeldorp, Michael B. Stokes, Prashanthan Sanders

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

BackgroundNew nonclinical parameters are needed to improve the current stroke risk stratification schemes for patients with atrial fibrillation. This study aimed to summarize data on potential cardiac imaging correlates and predictors of stroke or systemic embolism in patients with atrial fibrillation.MethodsMEDLINE, EMBASE, and Web of Science were searched to identify all published studies providing relevant data through 16 November 2022. Random effects meta-analysis method was used to pool estimates.ResultsWe included 64 studies reporting data from a pooled population of 56 639 patients. Left atrial spontaneous echo-contrast [adjusted odds ratio (aOR) 3.32, 95% confidence interval (CI) 1.98-5.49], nonchicken wing left atrial appendage (LAA) morphology (aOR 2.15, 95% CI 1.11-4.18), left atrial enlargement (aOR 2.12, 95% CI 1.45-3.08), and higher LAA orifice diameter (aOR 1.56, 95% CI 1.18-2.05) were highly associated with stroke. Other parameters associated with stroke included higher left atrial sphericity (aOR 1.14, 95% CI 1.01-1.29), higher left atrial volume (aOR 1.03, 95% CI 1.01-1.04), higher left atrial volume index (aOR 1.014, 95% CI 1.004-1.023), lower left atrial reservoir strain [adjusted hazard ratio (aHR) 0.86, 95% CI 0.76-0.98], higher left ventricular mass index (aOR 1.010, 95% CI 1.005-1.015) and E/e' ratio (aOR 1.12, 95% CI 1.07-1.16). There was no association between LAA volume (aOR 1.37, 95% CI 0.85-2.21) and stroke.ConclusionThese cardiac imaging parameters identified as potential predictors of thromboembolism may improve the accuracy of stroke risk stratification schemes in patients with atrial fibrillation. Further studies should evaluate the performance of holistic risk scores including clinical factors, biomarkers, and cardiac imaging.

Original languageEnglish
Pages (from-to)280-293
Number of pages14
JournalJournal of Cardiovascular Medicine
Volume25
Issue number4
DOIs
Publication statusPublished or Issued - 1 Apr 2024
Externally publishedYes

Keywords

  • atrial fibrillation
  • echocardiography
  • left atrial appendage
  • left atrium
  • left ventricle
  • stroke
  • thromboembolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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