Study on the occurrence of paroxysmal atrial fibrillation in acute ischemic stroke by measuring left atrial appendage parameters with transesophageal echocardiography

Liu Yang; Zhou Guoxia; Feng Dexi; Wang Lina

doi:10.3969/j.issn.1002-1949.2025.07.006

Abstract：Objective To explore the predictive value of left atrial appendage parameters measured by transesophageal echocardiography(TEE)for paroxysmal atrial fibrillation in acute ischemic stroke(AIS).Methods Data were collected from 300 AIS patients admitted to Inner Mongolia People's Hospital from January 2021 to August 2024.Upon admission,the patients underwent TEE examination to measure the parameters of left atrial appendage[left atrial appendage opening area(LAA-OA),left atrial appendage length(LAA-L),left atrial appendage volume(LAA-V),left atrial appendage emptying velocity(LAAEV),left atrial appendage filling velocity(LAAFV),left atrial appendage ejection fraction(LAAEF)].The patients underwent a 6-month follow-up to determine the occurrence of paroxysmal atrial fibrillation and were divided into the atrial fibrillation group(n=84)or the non-atrial fibrillation group(n=216).The parameters of the left atrial appendage measured by TEE in the two groups were compared,and receiver operating characteristic(ROC)curve was drawn to test the predictive value of relevant parameters for the risk of paroxysmal atrial fibrillation in AIS.Based on this result,a risk prediction model was constructed,and a decision curve was drawn to verify the predictive efficiency of the model.Results TEE examination showed that the LAAEV[cmn/s:(44.78±5.34)vs.(51.62±5.76)],LAAFV[cm/s:(47.56±6.15)vs.(53.28±6.82)]and LAAEF[％:(43.28±3.67)vs.(49.64±5.18)]of the atrial fibrillation group were lower than those of the non-atrial fibrillation group at admission(all P＜0.05),and there was no significant difference in LAA-OA,LAA-L and LAA-V between two groups(P＞0.05).ROC curve was drawn,and the AUC values of LAAEV,LAAFV and LAAEF alone or their combination for predicting the risk of paroxysmal atrial fibrillation in AIS were all≥ 0.7,indicating a certain predictive value,and the combined predictive value(AUC=0.921)was better.A risk prediction model of paroxysmal atrial fibrillation in AIS was constructed based on left atrial appendage parameters measured by TEE.The results showed that the model consistency index(C-index)was 0.921,the model discrimination was good,and the calibration curve fit well the ideal curve,indicating good accuracy of the model.Decision curve was drawn,within the threshold range of 0.00-0.89,the net benefit rate of LAAEV,LAAFV and LAAEF joint prediction for the risk of paroxysmal atrial fibrillation in AIS was higher than that of single parameter prediction,and joint prediction had a higher clinical benefit rate.Conclusions Left atrial appendage parameters LAAEV,LAAFV and LAAEF measured by TEE can be used to predict the risk of paroxysmal atrial fibrillation in AIS.The prediction model constructed based on the above parameters has high predictive value for the risk of paroxysmal atrial fibrillation in AIS.