الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 89 |  |  |
| | | from | 89 | | |
Abstract
Using of left atrial two-dimensional speckle tracking echocardiography after cryptogenic stroke/TIA has a great clinical implication for detection of left atrial cardiopathy and prediction of AF. Also trans-oesophageal echocardiography is an important modality in the work up for CS for exclusion of possible aetiologies for cardio-embolism which differs in primary management and secondary prevention to reduce risk of recurrence.
Our retrospective cohort study included 62 patients proved to have ischemic stroke or TIA of unknown aetiology admitted at stroke unit, Minia university hospital, Egypt and referred to Cardiology department for cardiac evaluation. High risk factors or recognized causes for ischemic stroke were excluded.
All participants were subjected to full history taking and full clinical examination. Brain imaging was done for diagnosis. 12-leads surface ECG and baseline trans-thoracic echocardiography were done.
Trans-oesophageal echocardiographic study was done.
Bilateral carotid duplex ultrasonography was done.
Two-dimensional speckle tracking echocardiographic study was done. Parameters of left atrial cardiopathy studied in our work included LA ejection fraction, LA strain during reservoir phase, LA maximal volume index and LV diastolic function.
Then, ECG rhythm monitoring during hospitalization for at least 48 hours was done seeking for episodes of paroxysmal AF.
22 Participants were excluded after performing TEE study due to presence of possible source of cardio-embolism including LAA thrombus, PFO or significant aortic arch atheroma.
40 participants with cryptogenic stroke (group I) were compared to another 40 healthy participants without previous history of medical significance as control group (group II). We assessed parameters of LA cardiopathy including LA diameter, LV diastolic dysfunction, LA volume index, LA ejection fraction and LA strain rate during reservoir phase and were compared between both groups.
No significant difference in LA diameter, LV diastolic dysfunction between both groups while there is significant difference in other parameters.
Participants of group I were monitored for 48 hours during hospitalization for detection of AF episodes more than 30 seconds. Parameters of LA cardiopathy were compared to each other for detection of its sensitivity, specificity in prediction of AF. We found that LA strain rate during reservoir phase is the most sensitive and specific parameter for AF prediction in comparison with LA maximal volume index, LA ejection fraction.
In conclusion, the diagnostic work-up for CS/TIA depends on performing TEE first searching for possible sources for cardio-embolism, if TEE couldn’t reach an objective evidence for cardio-embolism, LA speckle tracking is recommended. Patients with impaired parameters for LA cardiopathy particularly LA strain rate during reservoir phase are at high risk for AF and must be monitored for AF by periodic Holter-ECG monitoring in each follow up visit. Once AF diagnosed, anticoagulation therapy is recommended.
However, some limitations faced our study. Relatively small sample size was an important limitation. In addition to that follow up ECG by 48 hours rhythm monitoring during hospitalization is not enough for paroxysmal AF monitoring.
Further studies with larger number of patients and longer period of ECG monitoring for detecting subclinical AF are required, follow up of group I patients after tight control of risk factors and life style modification is recommended for detection of improvement or deterioration of left atrial cardiopathy.