{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:46:23Z","timestamp":1790660783435,"version":"4.1.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T00:00:00Z","timestamp":1695772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background and aims<\/jats:title><jats:p>Left atrial (LA) enlargement has been repeatedly shown to be associated with the diagnosis of atrial fibrillation (AF). In clinical practice, several parameters are available to determine LA enlargement: LA diameter index (LADI), LA area index (LAAI), or LA volume index (LAVI). We investigated the predictive power of these individual LA parameters for AF in patients with acute ischemic stroke or transient ischemic attack (TIA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>LAETITIA is a retrospective observational study that reflects the clinical reality of acute stroke care in Germany. Consecutive patient cases with acute ischemic cerebrovascular event (CVE) in 2019 and 2020 were identified from the Mannheim stroke database. Predictive power of each LA parameter was determined by the area under the curve (AUC) of receiver operating characteristic curves. A cutoff value was determined. A multiple logistic regression analysis was performed to confirm the strongest LA parameter as an independent predictor of AF in patients with acute ischemic CVE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,910 patient cases were included. In all, 82.0% of patients had suffered a stroke and 18.0% had a TIA. Patients presented with a distinct cardiovascular risk profile (reflected by a CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc score \u22652 prior to hospital admission in 85.3% of patients) and were moderately affected on admission [median NIHSS score 3 (1; 8)]. In total, 19.5% of patients had pre-existing AF, and 8.0% were newly diagnosed with AF. LAAI had the greatest AUC of 0.748, LADI of 0.706, and LAVI of 0.719 (each <jats:italic>p<\/jats:italic> &amp;lt; 0.001 vs. diagonal line; AUC-LAAI vs. AUC-LADI <jats:italic>p<\/jats:italic> = 0.030, AUC-LAAI vs. AUC-LAVI <jats:italic>p<\/jats:italic> = 0.004). LAAI, increasing NIHSS score on admission, and systolic heart failure were identified as independent predictors of AF in patients with acute ischemic CVE. To achieve a clinically relevant specificity of 70%, a cutoff value of \u226510.3 cm<jats:sup>2<\/jats:sup>\/m<jats:sup>2<\/jats:sup> was determined for LAAI (sensitivity of 69.8%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LAAI revealed the best prediction of AF in patients with acute ischemic CVE and was confirmed as an independent risk factor. An LAAI cutoff value of 10.3 cm<jats:sup>2<\/jats:sup>\/m<jats:sup>2<\/jats:sup> could serve as an inclusion criterion for intensified AF screening in patients with embolic stroke of undetermined source in subsequent studies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1237550","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T10:06:01Z","timestamp":1695895561000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Left atrial area index provides the best prediction of atrial fibrillation in ischemic stroke patients: results from the LAETITIA observational study"],"prefix":"10.3389","volume":"14","author":[{"given":"Angelika","family":"Alonso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Kraus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Ebert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeriya","family":"Nikolayenko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Kruska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesile","family":"Sandikci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Lesch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Duerschmied","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Platten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Baumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Szabo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Akin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Fastner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e022638","DOI":"10.1161\/JAHA.121.022638","article-title":"C, Ischemic stroke severity and mortality in patients with and without atrial fibrillation","volume":"11","author":"Vinding","year":"2022","journal-title":"J Am Heart Assoc."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1016\/j.amjmed.2021.07.027","article-title":"Ischemic stroke","volume":"134","author":"Feske","year":"2021","journal-title":"Am J Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1161\/CIRCULATIONAHA.114.010942","article-title":"Age-specific incidence, outcome, cost, and projected future burden of atrial fibrillation-related embolic vascular events: a population-based study","volume":"130","author":"Yiin","year":"2014","journal-title":"Circulation."},{"key":"B4","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/S1474-4422(15)70027-X","article-title":"Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis","volume":"14","author":"Sposato","year":"2015","journal-title":"Lancet Neurol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1093\/europace\/euw161","article-title":"EHRA\/HRS\/APHRS\/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication","volume":"18","author":"Goette","year":"2016","journal-title":"Europace."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1997","DOI":"10.1161\/STROKEAHA.119.025384","article-title":"Left atrial volume index is associated with cardioembolic stroke and atrial fibrillation detection after embolic stroke of undetermined source","volume":"50","author":"Jordan","year":"2019","journal-title":"Stroke."},{"key":"B8","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1159\/000508211","article-title":"Left atrial volume index predicts new-onset atrial fibrillation and stroke recurrence in patients with embolic stroke of undetermined source","volume":"49","author":"Tan","year":"2020","journal-title":"Cerebrovasc Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"26","DOI":"10.3389\/fneur.2020.00026","article-title":"Left atrial enlargement and the risk of stroke: a meta-analysis of prospective cohort studies","volume":"11","author":"Xu","year":"2020","journal-title":"Front Neurol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1884","DOI":"10.1136\/heartjnl-2019-315174","article-title":"Left atrial dimension and cardiovascular outcomes in patients with and without atrial fibrillation: a systematic review and meta-analysis","volume":"105","author":"Froehlich","year":"2019","journal-title":"Heart."},{"key":"B11","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.cardfail.2021.01.022","article-title":"Universal definition and classification of heart failure","volume":"28","author":"Bozkurt","year":"2021","journal-title":"J Card Fail."},{"key":"B12","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1159\/000210432","article-title":"Classification of stroke subtypes","volume":"27","author":"Amarenco","year":"2009","journal-title":"Cerebrovasc Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1016\/j.jacc.2005.08.077","article-title":"Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?","volume":"47","author":"Tsang","year":"2006","journal-title":"J Am Coll Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1635","DOI":"10.1016\/j.amjcard.2010.01.027","article-title":"Prognostic implications of left atrial volume index in patients in sinus rhythm","volume":"105","author":"Leung","year":"2010","journal-title":"Am J Cardiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ehj.2016.05.004","article-title":"Relation between left atrial measurements and thromboembolic risk markers assessed by echocardiography in patients with nonvalvular atrial fibrillation: a cross-sectional study","volume":"69","author":"Radwan","year":"2017","journal-title":"Egypt Heart J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e005196","DOI":"10.1161\/CIRCIMAGING.116.005196","article-title":"Complexities of left atrial analysis: more than meets the eye?","volume":"9","author":"Addetia","year":"2016","journal-title":"Circ Cardiovasc Imaging."},{"key":"B17","doi-asserted-by":"crossref","DOI":"10.1093\/med\/9780198713623.001.0001","volume-title":"The EACVI Echo Handbook.","author":"Lancellotti","year":""},{"key":"B18","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1016\/j.amjcard.2018.12.047","article-title":"Comparison of accuracy of left atrial area and volume by two-dimensional trans-thoracic echocardiography versus computed tomography","volume":"123","author":"Arsanjani","year":"2019","journal-title":"Am J Cardiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"W375","DOI":"10.2214\/AJR.09.3183","article-title":"Underestimation of left atrial size measured with transthoracic echocardiography compared with 3D MDCT","volume":"194","author":"Koka","year":"2010","journal-title":"AJR Am J Roentgenol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American heart association\/American stroke association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1177\/23969873221099478","article-title":"European stroke organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient Ischaemic attack of undetermined origin","author":"Rubiera","year":"","journal-title":"Eur Stroke J."},{"key":"B22","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.hrthm.2017.09.009","article-title":"Utility and limitations of long-term monitoring of atrial fibrillation using an implantable loop recorder","volume":"15","author":"Lee","year":"2018","journal-title":"Heart Rhythm."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2715","DOI":"10.1161\/STROKEAHA.121.035208","article-title":"Reexamination of the embolic stroke of undetermined source concept","volume":"52","author":"Albers","year":"2021","journal-title":"Stroke."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e012546","DOI":"10.1161\/JAHA.119.012546","article-title":"HEST score and prediction of incident atrial fibrillation in poststroke patients: a French nationwide study","volume":"8","author":"Li","year":"2019","journal-title":"J Am Heart Assoc."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1056\/NEJMoa1802686","article-title":"Rivaroxaban for stroke prevention after embolic stroke of undetermined source","volume":"378","author":"Hart","year":"2018","journal-title":"N Engl J Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1906","DOI":"10.1056\/NEJMoa1813959","article-title":"Dabigatran for prevention of stroke after embolic stroke of undetermined source","volume":"380","author":"Diener","year":"2019","journal-title":"N Engl J Med."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1237550\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T11:31:46Z","timestamp":1696332706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1237550\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,27]]},"references-count":26,"alternative-id":["10.3389\/fneur.2023.1237550"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2023.1237550","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,27]]},"article-number":"1237550"}}