• Koji Tanaka, Masatoshi Koga, Kazuaki Sato, Rieko Suzuki, Kazuo Minematsu, and Kazunori Toyoda.
• Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
• Int J Stroke. 2014 Dec 1;9(8):1045-51.

BackgroundAtrial fibrillation impairs left atrial appendage function and the thrombus formation in the left atrial appendage is a major cause of cardioembolic stroke.AimsTo evaluate the association between the volume of the left atrial appendage measured by real-time three-dimensional transesophageal echocardiography and presence of paroxysmal atrial fibrillation in patients with cerebral infarction or transient ischemic attack.MethodsReal-time three-dimensional transesophageal echocardiography was performed to measure left atrial appendage end-diastolic and end-systolic volumes to calculate left atrial appendage ejection fraction. Patients with normal sinus rhythm at the time of real-time three-dimensional transesophageal echocardiography were divided into groups with and without paroxysmal atrial fibrillation. Volumetric data were corrected with the body surface area.ResultsOf 146 patients registered, 102 (29 women, 72·2 ± 10·7 years) were normal sinus rhythm at the examination. In 23 patients with paroxysmal atrial fibrillation, left atrial appendage end-diastolic volume (4·78 ± 3·00 ml/m(2) vs. 3·14 ± 2·04 ml/m(2), P = 0·003) and end-systolic volume (3·10 ± 2·47 ml/m(2) vs. 1·39 ± 1·56 ml/m(2), P < 0·001) were larger and left atrial appendage ejection fraction (37·3 ± 19·1% vs. 57·1 ± 17·5%, P < 0·001) was lower than in the other 79 patients without paroxysmal atrial fibrillation. The optimal cutoff for left atrial appendage peak flow velocity to predict paroxysmal atrial fibrillation was 39·0 cm/s (sensitivity, 54·6%; specificity, 89·7%; c-statistic, 0·762). The cutoffs for left atrial appendage end-diastolic volume, end-systolic volume, and ejection fraction were 4·52 ml/m(2) (sensitivity, 47·8%; specificity, 82·3%; c-statistic, 0·694), 1·26 ml/m(2) (sensitivity, 91·3%; specificity, 60·3%; c-statistic, 0·806), and 47·9% (sensitivity, 78·3%; specificity, 74·7%; c-statistic, 0·774), respectively. In multivariate analysis, all these parameters were independently associated with paroxysmal atrial fibrillation after adjusting for sex, age, diabetes mellitus, and previous stroke.ConclusionsLeft atrial appendage volumetric analysis by real-time three-dimensional transesophageal echocardiography is a promising method for detecting paroxysmal atrial fibrillation in acute cerebral infarction or transient ischemic attack.© 2014 The Authors. International Journal of Stroke © 2014 World Stroke Organization.

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