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Published on: July 20, 2022
Changes in left atrial functional indexes in ischemic stroke patients
Chung-Wen Chen1, Shu-Yi Chen, Rey-Nein Tung
1Department of Neurology, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, ROC; School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
Insights
Acute ischemic stroke is linked to altered left atrial (LA) function, even without significant changes in LA size. Vector velocity imaging (VVI) effectively assesses these functional changes, highlighting the need for further research into LA functional indexes.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Increased left atrial (LA) size is a known predictor of cardiovascular events, including stroke.
- LA dysfunction can manifest independently of LA size.
- The relationship between stroke and LA functional changes remains poorly understood.
Purpose of the Study:
- To investigate the association between acute ischemic stroke and left atrial (LA) function.
- To evaluate the utility of vector velocity imaging (VVI) in assessing LA contractile characteristics in stroke patients.
Main Methods:
- Prospective enrollment of acute ischemic stroke patients and healthy controls, excluding those with significant cardiac arrhythmia or heart failure.
- Echocardiography examination including conventional parameters and vector velocity imaging (VVI) for LA and left ventricle contractile analysis.
- Comparison of mitral inflow velocities, LA volumes, and emptying function between stroke patients and controls.
Main Results:
- Stroke patients exhibited lower mitral inflow E-wave and higher A-wave velocities compared to controls.
- Active emptying percent of total LA emptying was significantly higher in stroke patients.
- Diastolic emptying index of the LA was significantly lower in stroke patients, despite no difference in maximal LA volume.
Conclusions:
- Acute ischemic stroke is associated with distinct alterations in mitral inflow velocities and LA emptying function.
- Vector velocity imaging (VVI) provides a convenient method for quantitative assessment of LA volumes and function.
- LA functional changes may precede or occur without significant structural changes, warranting further investigation into the clinical implications of LA functional indexes.
Background:
Increased left atrial (LA) size has been proposed as a predictor of multiple adverse cardiovascular events including stroke. LA dysfunction can occur in the absence of increased LA size. However, the relationship between stroke and changes in LA function is not well known.
Methods:
Patients with acute ischemic stroke and healthy controls were enrolled prospectively. Stroke patients received standard work-ups to determine the etiology of their strokes. Those patients with significant cardiac arrhythmia and heart failure were excluded. All participants received echocardiography examination. Conventional echocardiographic parameters were calculated and cardiac contractile characteristics of the left atrium and left ventricle were analyzed using vector velocity imaging (VVI) technique.
Results:
In total, 87 patients with acute ischemic stroke and 20 controls were recruited. The mitral inflow E-wave velocities were lower and A-wave velocities were higher in stroke patients (0.76 ± 0.19 vs. 0.84 ± 0.16, p = 0.048; and 0.97 ± 0.20 vs. 0.76 ± 0.11, p < 0.001 respectively). Stroke patients had a higher active emptying percent of total LA emptying (60.5 ± 19.0%) compared with that in controls (33.5 ± 11.7%, p < 0.001). The minimal LA volume was larger in stroke patients (15.0 ± 10.5 mL) than that in controls (9.9 ± 4.2 mL, p = 0.021), whereas there was no difference in maximal LA volume between stroke patients (37.3 ± 16.5 mL) and controls (33.3 ± 9.9 ml, p = 0.366). The diastolic emptying index of the LA was significantly lower in stroke patients compared with that in controls (61.4 ± 14.6% vs. 70.2 ± 11.0%, p = 0.016). The mitral A-wave velocity and active emptying percent of total LA emptying were significantly higher in all stroke subtypes than those in controls.
Conclusion:
Acute ischemic stroke patients had altered mitral inflow velocities and emptying function of the left atrium. VVI is convenient for quantitative assessment of left atrial volumes and contractile characteristics. Functional changes of LA may occur without significant structural changes. Therefore, the clinical implications of LA functional indexes require further study.
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