The role of left atrial strain and procollagen type 3 N-terminal peptit levels in detection of paroxysmal atrial fibrilation in patients with ischemic stroke

ABSTRACT Paroxysmal Atrial Fibrillation (PAF) which is an important etiological cause of ischemic stroke, has great importance in the prevention of secondary ischemic stroke. Although rhythm recorders are often used, and clinical and echocardiographic scoring are rarely used, currently there are still difficulties in detecting PAF. So we aimed to investigate the role of left atrial strain and procollagen type III N-terminal peptide (P3NP) levels in the detection of PAF, which is an etiologic cause of ischemic stroke in our study. Between 23/3/2016 - 7/10/2016, 100 patients (55 men, 45 women) with acute ischemic stroke were included in the study. Patients with acute ischemic stroke whose basal rhythm was sinus but had a spontaneous termination of atrial fibrillation detected by 24 hour holter monitorization were considered as PAF groups. Patients with acute ischemic stroke who did not have detected PAF by holter were accepted as the control group. Left atrial strain analysis was performed using an analysis package based on a speckle-tracking principle by manually drawing the left atrial endocardial borders through 2-dimensional gray scale images. Peak atrial systolic and diastolic velocities, peak atrial systolic strain, peak early and late diastolic strain, peak atrial systolic strain rate, peak early and late diastolic strain rate were measured by dividing atrial wall into 4 segments as atrial septum, lateral, inferior and anterior wall. Serum P3NP levels of all patients were measured. The mean age of the patients was 68.5 ± 14.3 years and 55% were male. Left atrial diameters in PAF group were larger than control group (p <0,05). Left atrial peak systolic strain measurements of patients with PAF were significantly lower than those of the control group (p <0.05). Similarly, left atrial septal early and late diastolic strain rate measurements, anterior and inferior early diastolic strain rate measurements were also found to be lower in the PAF group than in the control group (p <0.05). P3NP levels in patients with PAF were significantly higher than those in the control group (27768,5 ± 47703.5 pg / ml vs 13328,4 ± 21299.9 pg / ml, p <0,05). Left atrial strain was 26.5% with 82% sensitivity and 62% specificity, P3NP level was 7416.5 pg / ml with 74% sensitivity and 52% specificity,as indicating presence of PAF. As a result; In patients with PAF; left atrial strain decreased, P3NP levels increased and left atrium dilated secondary to left atrial fibrosis. Although the P3NP level and left atrial peak systolic strain parameters may be used in clinic practice to demonstrate the presence of PAF, a large series is needed to achieve standardization. Keywords: Atrial fibrillation, atrial strain, procollagen type III N-terminal peptide, ischemic stroke