Predictive value of left and right atrial strain for the detection of device-detected atrial fibrillation in patients with cryptogenic stroke and implantable cardiac monitor

Background and objective: Device-detected atrial fibrillation (DDAF) is frequently identified using implantable cardiac monitors (ICMs) following cryptogenic stroke (CS). While left atrium (LA) echocardiographic parameters have been linked to DDAF risk, right atrial (RA) parameters remain underexplored. This study aimed to assess the relationship between speckle-tracking echocardiography parameters and the occurrence of DDAF detected via ICM in patients with CS. Methods: We retrospectively analyzed consecutive CS patients who received an ICM at our institution. All underwent transthoracic echocardiography to evaluate LA, RA, left and right ventricle (LV, RV) function using standard and strain-derived parameters. The primary endpoint was the first DDAF episode lasting >6 min recorded by ICM. Results: Between May 2013 and July 2022, 204 patients (82 % males, median age 69 years) received an ICM. Over a median follow-up of 15.3 months [interquartile range: 7.4-23.5], DDAF was detected in 96 patients (47.0 %). LA peak longitudinal strain (adjusted-hazard ratio [HR] 0.87, 95 %CI 0.84-0.89, p < 0.001), peak conduit strain (adjusted-HR 1.17, 95 %CI 1.13-1.22, p < 0.001), and peak contraction strain (adjusted-HR 1.17, 95 % CI 1.11-1.22, p < 0.001) significantly predicted DDAF. RA peak longitudinal strain (adjusted-HR 0.89, 95 % CI 0.83-0.95, p < 0.001) and peak contraction strain (adjusted-HR 1.39, 95 % CI 1.26-1.53, p < 0.001) were also predictive, but peak conduit strain was not (p = 0.103). No significant associations were found for LV or RV parameters. Conclusions: LA and RA strain analyses are valuable for predicting DDAF detection following CS and can aid in risk stratification before ICM insertion.