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The Role of Left Atrial Volume Index in Patients with a First-ever Acute Ischemic Stroke
Murat Biteker1, Kadir Kayataş2, Özcan Başaran1
1Faculty of Medicine, Department of Cardiology, Mugla Sitki Kocman Universitesi, Muğla, Turkey.
Insights
Enlarged left atrial volume index (LAVI) helps identify cardioembolic stroke and predicts mortality in acute ischemic stroke (AIS) patients. Higher LAVI indicates increased risk, aiding in stroke subtype classification and prognosis.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Enlarged left atrium is a known adverse outcome marker in various diseases.
- Its role in acute ischemic stroke (AIS) discrimination and prognosis is understudied.
Purpose of the Study:
- To investigate if left atrial volume index (LAVI) predicts mortality in AIS patients.
- To determine if LAVI discriminates between stroke subtypes in AIS.
Main Methods:
- Prospective follow-up of 310 first-ever AIS patients (≥50 years) within 24 hours of symptom onset.
- AIS classification using Trial of Org 10172 in Acute Stroke Treatment (TOAST).
- Transthoracic echocardiography within 24 hours to measure LAVI; categorized into four groups.
Main Results:
- Mean LAVI was significantly higher in cardioembolic vs. noncardioembolic stroke (32.4 ± 4.0 vs. 29.7 ± 3.4 mL/m², P < .001).
- Optimal LAVI cutoff for cardioembolic stroke: 30 mL/m² (sensitivity 81%, specificity 64%).
- Mortality increased progressively with LAVI categories (4% to 70.9%), showing a stepwise increase in mortality risk.
Conclusions:
- LAVI effectively distinguishes cardioembolic from noncardioembolic stroke.
- LAVI provides independent prognostic information for mortality prediction in AIS patients.
- LAVI offers value beyond clinical and other echocardiographic variables in 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.
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