INTRODUCTION AND OBJECTIVES: Stroke etiology remains undetermined in up to 30% of cases. Paroxysmal atrial fibrillation is found in 20% to 28% of patients with stroke initially classified as being of undetermined etiology. The aim of our study was to analyze left atrial function in ischemic stroke patients to identify patterns associated with cardioembolic etiology and to determine whether the patterns identified can be found in individuals initially classified as having a stroke of undetermined etiology. METHODS: We studied a cohort of in-hospital ischemic stroke patients referred for transthoracic echocardiography. Treating neurologists determined stroke etiology based on the TOAST classification. Left atrial contractile function was assessed using 2-dimensional echocardiography to determine their ejection fraction and speckle tracking to measure left atrial strain rate: a-wave. Left atrial function was compared between stroke etiology subgroups and healthy controls. RESULTS: Ninety-seven patients (aged 67±15 years) with ischemic stroke (16.5% large-artery atherosclerosis, 15.5% small-vessel occlusion, 11.3% cardioembolic, 5.1% other determined etiology, 51.1% undetermined etiology) and 10 healthy volunteers (aged 63±7 years) were included. Left atrial ejection fraction was significantly decreased only in patients with stroke of cardioembolic and undetermined etiology compared with the control group (31.5±17.2%, 40.2±17.1%, and 59.1±8.4%, respectively; P=.004). The left atrial strain rate was significantly lower in patients with stroke caused by cardioembolic or undetermined etiology, or large-artery atherosclerosis compared with controls (-0.86±0.49, -1.31±0.56, -1.5±0.47, -2.37±1.18, respectively; P<.001). CONCLUSIONS: Patients with stroke of undetermined etiology with left atrial function (ejection fraction and strain) similar to that of cardioembolic stroke patients may be misclassified and could potentially benefit from prolonged electrocardiography monitoring. Left atrial function analysis (ejection fraction and strain) might help to identify potential cardioembolic sources in patients with stroke of undetermined etiology.
INTRODUCTION AND OBJECTIVES:Stroke etiology remains undetermined in up to 30% of cases. Paroxysmal atrial fibrillation is found in 20% to 28% of patients with stroke initially classified as being of undetermined etiology. The aim of our study was to analyze left atrial function in ischemic strokepatients to identify patterns associated with cardioembolic etiology and to determine whether the patterns identified can be found in individuals initially classified as having a stroke of undetermined etiology. METHODS: We studied a cohort of in-hospital ischemic strokepatients referred for transthoracic echocardiography. Treating neurologists determined stroke etiology based on the TOAST classification. Left atrial contractile function was assessed using 2-dimensional echocardiography to determine their ejection fraction and speckle tracking to measure left atrial strain rate: a-wave. Left atrial function was compared between stroke etiology subgroups and healthy controls. RESULTS: Ninety-seven patients (aged 67±15 years) with ischemic stroke (16.5% large-artery atherosclerosis, 15.5% small-vessel occlusion, 11.3% cardioembolic, 5.1% other determined etiology, 51.1% undetermined etiology) and 10 healthy volunteers (aged 63±7 years) were included. Left atrial ejection fraction was significantly decreased only in patients with stroke of cardioembolic and undetermined etiology compared with the control group (31.5±17.2%, 40.2±17.1%, and 59.1±8.4%, respectively; P=.004). The left atrial strain rate was significantly lower in patients with stroke caused by cardioembolic or undetermined etiology, or large-artery atherosclerosis compared with controls (-0.86±0.49, -1.31±0.56, -1.5±0.47, -2.37±1.18, respectively; P<.001). CONCLUSIONS:Patients with stroke of undetermined etiology with left atrial function (ejection fraction and strain) similar to that of cardioembolic strokepatients may be misclassified and could potentially benefit from prolonged electrocardiography monitoring. Left atrial function analysis (ejection fraction and strain) might help to identify potential cardioembolic sources in patients with stroke of undetermined etiology.
Authors: Flemming J Olsen; Louisa M Christensen; Derk W Krieger; Søren Højberg; Nis Høst; Finn M Karlsen; Jesper H Svendsen; Hanne Christensen; Tor Biering-Sørensen Journal: Int J Cardiovasc Imaging Date: 2019-10-08 Impact factor: 2.357
Authors: Gabriella Bufano; Francesco Radico; Carolina D'Angelo; Francesca Pierfelice; Maria Vittoria De Angelis; Massimiliano Faustino; Sante Donato Pierdomenico; Sabina Gallina; Giulia Renda Journal: Front Cardiovasc Med Date: 2022-04-25
Authors: Mohammadali Habibi; Mytra Zareian; Bharath Ambale Venkatesh; Sanaz Samiei; Masamichi Imai; Colin Wu; Lenore J Launer; Steven Shea; Rebecca F Gottesman; Susan R Heckbert; David A Bluemke; João A C Lima Journal: JACC Cardiovasc Imaging Date: 2019-04-17
Authors: Hooman Kamel; Traci M Bartz; W T Longstreth; Mitchell S V Elkind; John Gottdiener; Jorge R Kizer; Julius M Gardin; Jiwon Kim; Sanjiv Shah Journal: Sci Rep Date: 2021-08-30 Impact factor: 4.379