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Left Atrial Volume Index Is Associated With Cardioembolic Stroke and Atrial Fibrillation Detection After Embolic
Kevin Jordan1, Shadi Yaghi2,3, Athena Poppas1
1From the Division of Cardiology, Department of Internal Medicine (K.J., A.P., C.S.), the Warren Alpert Medical School of Brown University, Providence, RI.
Insights
Left atrial enlargement is linked to cardioembolic stroke and atrial fibrillation detection in embolic stroke of unknown source. Increased left atrial volume index may identify patients who could benefit from anticoagulation therapy for stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Left atrial enlargement is a known risk factor for ischemic stroke.
- The association between left atrial volume index (LAVI) and specific embolic stroke mechanisms, particularly embolic stroke of undetermined source (ESUS), is not well understood.
Purpose of the Study:
- To investigate the relationship between LAVI and different embolic stroke subtypes.
- To determine if LAVI is associated with the detection of atrial fibrillation (AF) in patients with ESUS.
Main Methods:
- Prospective cohort study of ischemic stroke patients.
- Classification of stroke subtypes: cardioembolic stroke, noncardioembolic stroke (NCE), and ESUS.
- Measurement of LAVI using transthoracic echocardiography and multivariable logistic regression analyses.
Main Results:
- LAVI was significantly greater in cardioembolic stroke patients compared to NCE.
- No significant difference in LAVI was found between ESUS and NCE patients.
- In ESUS patients, LAVI was independently associated with the detection of AF during cardiac monitoring (18.2% detection rate).
Conclusions:
- LAVI is associated with cardioembolic stroke and AF detection in ESUS.
- Increased LAVI may help identify ESUS patients who could benefit from anticoagulation therapy for stroke prevention.
Abstract:
Background and Purpose- Left atrial enlargement has been shown to be associated with ischemic stroke, but the association with embolic stroke mechanisms remains unknown. We aim to study the associations between left atrial volume index (LAVI) and embolic stroke subtypes and atrial fibrillation (AF) detection on cardiac event monitoring in patients with embolic stroke of unknown source. Methods- Data were collected from a prospective cohort of consecutive patients with ischemic stroke admitted to a comprehensive stroke center over 18 months. Stroke subtype was classified into cardioembolic stroke, noncardioembolic stroke of determined mechanism (NCE), or embolic stroke of undetermined source (ESUS). Univariate and prespecified multivariable analyses were performed to assess associations between LAVI and stroke subtype and AF detection in patients with ESUS. Results- Of 1224 consecutive patients identified during the study period, 1020 (82.6%) underwent transthoracic echocardiography and had LAVI measurements. LAVI was greater in patients with cardioembolic stroke than NCE (41.4 mL/m2±18.0 versus 28.6 mL/m2±12.2; P<0.001) but not in ESUS versus NCE (28.9 mL/m2±12.6 versus 28.6 mL/m2±12.2; P=0.61). In multivariable logistic regression models, LAVI was greater in cardioembolic stroke versus NCE (adjusted odds ratio per mL/m2, 1.07; 95% CI, 1.05-1.09; P<0.001) but not in ESUS versus NCE (adjusted odds ratio per mL/m2, 1.00; 95% CI, 0.99-1.02; P=0.720). Among 99 patients with ESUS who underwent cardiac monitoring, 18.2% had AF detected; LAVI was independently associated with AF detection in ESUS (adjusted odds ratio per mL/m2, 1.09; 95% CI, 1.02-1.15; P=0.007). Conclusions- LAVI is associated with cardioembolic stroke as well as AF detection in patients with ESUS, 2 subsets of ischemic stroke that benefit from anticoagulation therapy. Patients with increased LAVI may be a subgroup where anticoagulation may be tested for stroke prevention.
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