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Left Atrial Function Is Impaired in Some Patients With Stroke of Undetermined Etiology: Potential Implications for
Laura Sanchis1, Silvia Montserrat1, Víctor Obach2
1Departamento de Cardiología, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Spain.
Insights
Left atrial function analysis in ischemic stroke patients reveals patterns similar to cardioembolic stroke. This suggests patients with undetermined stroke etiology may be misclassified and could benefit from further monitoring.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Up to 30% of stroke cases have an undetermined etiology.
- Paroxysmal atrial fibrillation is a common finding in patients with cryptogenic stroke.
Purpose of the Study:
- To analyze left atrial function in ischemic stroke patients.
- To identify patterns associated with cardioembolic stroke etiology.
- To determine if these patterns are present in strokes of undetermined etiology.
Main Methods:
- Transthoracic echocardiography was used to assess left atrial function in ischemic stroke patients.
- Left atrial ejection fraction and strain rate were measured using 2D echocardiography and speckle tracking.
- Stroke etiology was classified using the TOAST criteria.
Main Results:
- Patients with cardioembolic and undetermined stroke etiologies showed significantly decreased left atrial ejection fraction compared to controls.
- Left atrial strain rate was significantly lower in patients with cardioembolic, undetermined, or large-artery atherosclerosis stroke compared to controls.
- Abnormal left atrial function was observed in over half of the stroke patients studied.
Conclusions:
- Left atrial function analysis may help identify potential cardioembolic sources in patients with stroke of undetermined etiology.
- Patients with undetermined stroke etiology exhibiting left atrial dysfunction similar to cardioembolic stroke may be misclassified.
- Prolonged electrocardiography monitoring could benefit patients with undetermined stroke etiology who show signs of left atrial dysfunction.
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.
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