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Left atrial deformation parameters predict left atrial appendage function and thrombus in patients in sinus rhythm
Can Yücel Karabay1, Regayip Zehir, Ahmet Güler
1Cardiology Clinic, Kartal Koşuyolu Heart & Research Hospital, Istanbul, Turkey. karabaymd@yahoo.com
Insights
Left atrial deformation analysis using speckle tracking echocardiography effectively predicts left atrial appendage thrombus in stroke patients in sinus rhythm. This non-invasive method identifies impaired left atrial appendage function, crucial for cardioembolic stroke risk assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Stroke Medicine
Background:
- Cardioembolic stroke poses a significant risk, often originating from the left atrial appendage (LAA).
- Detecting LAA thrombus is critical for stroke prevention, but traditional methods can be invasive or limited in sinus rhythm patients.
- Assessing LAA function in patients with suspected cardioembolic stroke in sinus rhythm requires advanced imaging techniques.
Purpose of the Study:
- To evaluate left atrial (LA) deformations via speckle tracking echocardiography (STE) for predicting LAA thrombus.
- To assess the utility of LA strain parameters in identifying LAA thrombus in ischemic stroke patients in sinus rhythm.
- To correlate LA deformation with LAA morphology and function in patients with suspected cardioembolic stroke.
Main Methods:
- 153 ischemic stroke patients in sinus rhythm with suspected cardioembolism underwent conventional 2D echocardiography and 2D STE.
- Left atrial peak reservoir strain (LA-4C-RES) and precontraction strain (LA-4C-PUMP) were measured.
- Patients were categorized based on the presence of LAA thrombus confirmed by transesophageal echocardiography.
Main Results:
- Significantly lower LA-4C-RES and LA-4C-PUMP values were observed in patients with LAA thrombus compared to those without.
- LA-4C-RES showed strong inverse correlations with LAA area and length, and a positive correlation with LAA emptying velocity.
- Receiver-operating characteristic curve analysis demonstrated high accuracy (AUC 0.94 for LA-4C-RES, 0.92 for LA-4C-PUMP) in predicting LAA thrombus.
Conclusions:
- 2D STE-derived LA deformation parameters accurately predict impaired LAA function and the presence of LAA thrombus.
- This technique offers a valuable, non-invasive tool for risk stratification in ischemic stroke patients with suspected cardioembolism in sinus rhythm.
- LA deformation analysis by STE can improve the detection of LAA thrombus, guiding therapeutic decisions in stroke management.
Abstract:
The aim of this study was to evaluate left atrial deformations using speckle tracking echocardiography for predicting left atrial appendage (LAA) thrombus in patients with suspected cardioembolic stroke who were in normal sinus rhythm. A total of 153 ischemic stroke patients (89 males, 64 females) in sinus rhythm who were suspected of having cardioembolism were included in the study. The patients underwent conventional two-dimensional (2D) echocardiogram and 2D speckle tracking echocardiogram of the left atrium. Left atrial peak strain (LA-4C-RES) and left atrial precontraction strain (LA-4C-PUMP) were measured. Patients were divided into 2 groups according to the presence of thrombus in the LAA in transesophageal echocardiography. Both LA-4C-RES and LA-4C-PUMP values were found to be significantly lower in patients with LAA thrombus (11.8 ± 1.4% vs. 33 ± 12%, P < 0.001 and 5.8 ± 1.3% vs. 14.2 ± 5.3%, P < 0.001, respectively). A good inverse correlation was present between LA-4C-RES values and LAA morphologic parameters (with LAA area: r = -0.70, P < 0.001, with LAA length: r = -0.60, P < 0.001), and a good positive correlation was present with LAA emptying velocity with pulse Doppler (r = 0.74, P < 0.001). The area under the receiver-operating characteristic curve of the LA-4C-RES was 0.94 (0.90-0.98, P < 0.001), for the LA-4C-PUMP, the area was 0.92 (0.87-0.96, P < 0.001) to predict LAA thrombus. Left atrial deformation parameters measured by 2D speckle tracking method was found to predict impaired LAA functions and the presence of LAA thrombus in ischemic stroke patients with suspected cardioembolism, but who are in sinus rhythm.
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