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  • Title: Transthoracic echocardiography to rule out paroxysmal atrial fibrillation as a cause of stroke or transient ischemic attack.
    Author: Stahrenberg R, Edelmann F, Haase B, Lahno R, Seegers J, Weber-Krüger M, Mende M, Wohlfahrt J, Kermer P, Vollmann D, Hasenfuss G, Gröschel K, Wachter R.
    Journal: Stroke; 2011 Dec; 42(12):3643-5. PubMed ID: 21998056.
    Abstract:
    BACKGROUND AND PURPOSE: We assessed whether echocardiography can predict paroxysmal atrial fibrillation (PAF) in patients with cerebral ischemia presenting in sinus rhythm. METHODS: Within the prospective Find-AF cohort, 193 consecutive patients with cerebral ischemia and sinus rhythm on presentation had evaluation of echocardiographic parameters of left atrial size and function. PAF was diagnosed by 7-day Holter monitoring. RESULTS: In 26 patients with PAF, late diastolic Doppler (A) and tissue Doppler (a') velocities were lower whereas left atrial diameter, left atrial volume index (LAVI), LAVI/A, and LAVI/a' were larger (P<0.05 for all) than they were in 167 patients without PAF. In multivariate models A, a', LAVI/A, and LAVI/a' predicted the presence of PAF. Area under the receiver operating characteristic curve to diagnose PAF was highest for LAVI/a' (0.813 [0.738; 0.889]). A previously suggested cut-off of LAVI/a'<2.3 had 92% sensitivity, 55.8% specificity, and 98% negative predictive value for PAF. CONCLUSIONS: LAVI/a'<2.3 can effectively rule out PAF in patients with cerebral ischemia.
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