Murat Biteker1, Kadir Kayataş2, Özcan Başaran3, Volkan Dogan3, Eda Özlek3, Bülent Özlek3. 1. Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman Universitesi, Muğla, Turkey. Electronic address: murbit2@yahoo.com. 2. Department of Internal Medicine, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey. 3. Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman Universitesi, Muğla, Turkey.
Abstract
BACKGROUND: Although an enlarged left atrium has recently emerged as a marker of adverse outcomes in various diseases, its discriminatory value and prognostic role in acute ischemic stroke (AIS) are not well studied. We studied whether left atrial volume index (LAVI) predicts mortality and discriminates stroke subtypes after AIS. METHODS: We prospectively followed 310 consecutive first-ever AIS patients aged 50 years or older who were admitted to the hospital within 24 hours of the onset of stroke symptoms. The type of AIS was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. All of the patients underwent transthoracic echocardiography within the first 24 hours. LAVI was measured with the biplane area-length method and categorized as 28 mL/m2 or lower (normal), 28.1-32 mL/m2, 32.1-36 mL/m2, and >36 mL/m2. The patients were followed for 1 year or until death, whichever came first. RESULTS: The LAVI of the cardioembolic group was significantly higher than that of the noncardioembolic group (32.4 ± 4.0 versus 29.7 ± 3.4 mL/m2, respectively; P < .001). The optimal cutoff value, sensitivity, and specificity of LAVI to distinguish cardioembolic stroke from noncardioembolic stroke were 30 mL/m2, 81%, and 64%, respectively. Mortality in each LAVI category was 4%, 7.8%, 25.9%, and 70.9%, respectively (P = .026). Kaplan-Meier analysis showed that there was a stepwise increase in risk of mortality with each increment of LAVI category. CONCLUSIONS: The LAVI can distinguish cardioembolic stroke from noncardioembolic stroke and provides an independent information over clinical and other echocardiographic variables for predicting mortality in patients with first-ever AIS.
BACKGROUND: Although an enlarged left atrium has recently emerged as a marker of adverse outcomes in various diseases, its discriminatory value and prognostic role in acute ischemic stroke (AIS) are not well studied. We studied whether left atrial volume index (LAVI) predicts mortality and discriminates stroke subtypes after AIS. METHODS: We prospectively followed 310 consecutive first-ever AIS patients aged 50 years or older who were admitted to the hospital within 24 hours of the onset of stroke symptoms. The type of AIS was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. All of the patients underwent transthoracic echocardiography within the first 24 hours. LAVI was measured with the biplane area-length method and categorized as 28 mL/m2 or lower (normal), 28.1-32 mL/m2, 32.1-36 mL/m2, and >36 mL/m2. The patients were followed for 1 year or until death, whichever came first. RESULTS: The LAVI of the cardioembolic group was significantly higher than that of the noncardioembolic group (32.4 ± 4.0 versus 29.7 ± 3.4 mL/m2, respectively; P < .001). The optimal cutoff value, sensitivity, and specificity of LAVI to distinguish cardioembolic stroke from noncardioembolic stroke were 30 mL/m2, 81%, and 64%, respectively. Mortality in each LAVI category was 4%, 7.8%, 25.9%, and 70.9%, respectively (P = .026). Kaplan-Meier analysis showed that there was a stepwise increase in risk of mortality with each increment of LAVI category. CONCLUSIONS: The LAVI can distinguish cardioembolic stroke from noncardioembolic stroke and provides an independent information over clinical and other echocardiographic variables for predicting mortality in patients with first-ever AIS.
Authors: Paulina E Gąsiorek; Maciej Banach; Marek Maciejewski; Andrzej Głąbiński; Aleksandra Paduszyńska; Jacek Rysz; Agata Bielecka-Dąbrowa Journal: Cardiol J Date: 2018-05-02 Impact factor: 2.737