Table_1_Left atrial area index provides the best prediction of atrial fibrillation in ischemic stroke patients: results from the LAETITIA observational study.pdf

Background and aimsLeft atrial (LA) enlargement has been repeatedly shown to be associated with the diagnosis of atrial fibrillation (AF). In clinical practice, several parameters are available to determine LA enlargement: LA diameter index (LADI), LA area index (LAAI), or LA volume index (LAVI). We investigated the predictive power of these individual LA parameters for AF in patients with acute ischemic stroke or transient ischemic attack (TIA).
MethodsLAETITIA is a retrospective observational study that reflects the clinical reality of acute stroke care in Germany. Consecutive patient cases with acute ischemic cerebrovascular event (CVEs) in 2019 and 2020 were identified from the Mannheim stroke database. Predictive power of each LA parameter was determined by the area under the curve (AUC) of receiver operating characteristic curves. A cutoff value was determined. A multiple logistic regression analysis was performed to confirm the strongest LA parameter as an independent predictor of AF in patients with acute ischemic CVE.
ResultsA total of 1,910 patient cases were included. In all, 82.0% of patients had suffered a stroke and 18.0% had a TIA. Patients presented with a distinct cardiovascular risk profile (reflected by a CHA2DS2-VASc score ≥2 prior to hospital admission in 85.3% of patients) and were moderately affected on admission [median NIHSS score 3 (1; 8)]. In total, 19.5% of patients had pre-existing AF, and 8.0% were newly diagnosed with AF. LAAI had the greatest AUC of 0.748, LADI of 0.706, and LAVI of 0.719 (each p < 0.001 vs. diagonal line; AUC-LAAI vs. AUC-LADI p = 0.030, AUC-LAAI vs. AUC-LAVI p = 0.004). LAAI, increasing NIHSS score on admission, and systolic heart failure were identified as independent predictors of AF in patients with acute ischemic CVE. To achieve a clinically relevant specificity of 70%, a cutoff value of ≥10.3 cm2/m2 was determined for LAAI (sensitivity of 69.8%).
ConclusionLAAI revealed the best prediction of AF in patients with acute ischemic CVE and was confirmed as an independent risk factor. An LAAI cutoff value of 10.3 cm2/m2 could serve as an inclusion criterion for intensified AF screening in patients with embolic stroke of undetermined source in subsequent studies.

背景与目的：左心房（Left atrial, LA）扩大已被多项研究证实与心房颤动（atrial fibrillation, AF）的诊断密切相关。临床实践中，评估左心房扩大的常用参数包括左心房直径指数（Left atrial diameter index, LADI）、左心房面积指数（Left atrial area index, LAAI）及左心房容积指数（Left atrial volume index, LAVI）。本研究旨在探讨上述各项左心房参数对急性缺血性脑卒中或短暂性脑缺血发作（transient ischemic attack, TIA）患者发生房颤的预测效能。

方法：LAETITIA是一项回顾性观察性研究，旨在反映德国急性卒中诊疗的临床实际场景。研究纳入2019年至2020年连续收治的急性缺血性脑血管事件（cerebrovascular event, CVE）患者病例，数据来源于曼海姆卒中数据库。采用受试者工作特征曲线下面积（area under the curve, AUC）评估各项左心房参数的预测价值，并确定其最优截断值；通过多因素logistic回归分析，明确可作为急性缺血性CVE患者房颤独立预测因子的最佳左心房参数。

结果：本研究共纳入1910例患者病例，其中82.0%为缺血性脑卒中患者，18.0%为TIA患者。患者均存在明确的心血管危险因素（85.3%的患者入院前CHA₂DS₂-VASc评分≥2分），入院时病情处于中等程度受累状态[中位美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分3(1;8)]。总体而言，19.5%的患者存在既往房颤病史，8.0%的患者为新发房颤。LAAI的AUC最高，为0.748；LADI为0.706，LAVI为0.719（各项参数与参考线比较均p<0.001；LAAI与LADI的AUC比较p=0.030，LAAI与LAVI的AUC比较p=0.004）。多因素回归分析显示，LAAI、入院时NIHSS评分升高及收缩性心力衰竭为急性缺血性CVE患者发生房颤的独立预测因子。为达到临床相关的70%特异性，LAAI的截断值设定为≥10.3 cm²/m²，此时对应灵敏度为69.8%。

结论：LAAI对急性缺血性CVE患者的房颤预测效能最佳，且被证实为独立危险因素。后续研究中，LAAI≥10.3 cm²/m²的截断值可作为隐源性栓塞性脑卒中患者强化房颤筛查的纳入标准。