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Clinical and echocardiographic characteristics of cardioembolic stroke
Insights
Cardioembolic stroke is often linked to enlarged left atria with impaired function. Left atrial function index (LAFI) emerged as a key predictor for identifying cardioembolic stroke causes.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Ischaemic stroke frequently originates from a cardioembolic (CE) source.
- Identifying the aetiology of stroke is crucial for effective treatment and prevention.
Purpose of the Study:
- To evaluate clinical and echocardiographic parameters associated with cardioembolic stroke.
- To determine if left atrial (LA) parameters can predict CE stroke.
Main Methods:
- Retrospective analysis of 93 ischaemic stroke patients undergoing transthoracic echocardiography.
- Stroke classification using TOAST criteria.
- Comparison of echocardiographic parameters, including LA volumes and function, between CE stroke patients and healthy controls.
Main Results:
- 41% of patients had CE stroke. Patients with CE stroke exhibited larger LA maximum and minimum volumes (LAVImax, LAVImin) and reduced LA function (LA emptying fraction, LAFI) compared to non-CE patients.
- LAFI ≤0.3 was an independent predictor of CE stroke (adjusted odds ratio 5.3).
- Patients with undetermined stroke aetiology showed enlarged LA volumes and reduced LAFI compared to controls, suggesting potential underlying LA myopathy.
Conclusions:
- Left atrial enlargement and reduced function are associated with cardioembolic stroke.
- LAFI is a significant independent predictor of CE stroke.
- Altered LA parameters in undetermined stroke aetiology suggest a possible role for LA myopathy in this patient subset.
Background And Purpose:
Ischaemic stroke frequently has a cardioembolic (CE) source. Clinical and echocardiographic parameters associated with CE stroke were evaluated.
Methods:
In all, 93 consecutive ischaemic stroke patients who underwent a transthoracic echocardiogram were retrospectively analysed; strokes were classified by TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Echocardiographic parameters related to CE stroke, including left atrial volumes and function, were compared to 73 healthy controls.
Results:
Of 93 patients (mean age 66.1 years, 56% male), nine (10%) had large artery atherosclerosis, 38 (41%) CE stroke, two (2%) small vessel disease, two (2%) other and 42 (45%) undetermined aetiology. Left atrial (LA) maximum volumes (LAVImax ) and minimum volumes (LAVImin ) were larger in the CE group than the non-CE group (45 vs. 32 ml/m2 , 32 vs. 13 ml/m2 , respectively, P < 0.001), whilst LA function indices including LA emptying fraction and LA function index (LAFI) were lower in the CE group (34% vs. 55%, and 0.12 vs. 0.35, respectively, P < 0.001). Adjusting for clinical characteristics, LAFI ≤0.3 was an independent predictor of CE stroke (adjusted odds ratio 5.3, P = 0.001). Additionally, LAVImax and LAVImin were larger (61 vs. 44 and 32 vs. 24 ml/m2 respectively, P < 0.01) and LAFI significantly lower (0.34 vs. 0.52, P < 0.001) in the undetermined aetiology group versus healthy controls.
Conclusions:
Left atrial enlargement with reduced LA function was associated with CE stroke and LAFI was the best independent predictor. LA parameters were also altered in the undetermined aetiology group, suggesting an underlying LA myopathy in this subset.
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