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Relationship between left atrial volume and ischemic stroke subtype

Hooman Kamel1, Peter M Okin2, Alexander E Merkler1

  • 1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, New York.

Annals of Clinical and Translational Neurology
|August 13, 2019
PubMed

Insights

Larger left atrial volume is associated with embolic strokes of undetermined source (ESUS), even without atrial fibrillation. This finding suggests atrial cardiopathy contributes to ESUS risk.

Area of Science:

  • Cardiology
  • Neurology
  • Stroke Medicine

Background:

  • Atrial cardiopathy without atrial fibrillation (AF) is a potential cause of embolic strokes of undetermined source (ESUS).
  • Atrial volume is a key indicator of atrial cardiopathy, but its direct link to ESUS remains unclear.

Purpose of the Study:

  • To investigate the relationship between left atrial volume index (LAVI) and stroke subtypes, specifically focusing on ESUS.
  • To determine if increased LAVI is independently associated with ESUS.

Main Methods:

  • Retrospective analysis of the Cornell Acute Stroke Academic Registry (CAESAR) from 2011-2016.
  • Comparison of LAVI across ischemic stroke subtypes (ESUS, cardioembolic, small-vessel, large-vessel) using t-tests, ANOVA, and targeted minimum loss-based estimation for adjusted analyses.
  • LAVI measurements were obtained from echocardiography reports.

Main Results:

  • A total of 1293 patients with LAVI measurements were analyzed.
  • LAVI was significantly larger in ESUS (33.3 ± 13.6 mL/m²) compared to small- or large-vessel stroke (30.9 ± 10.7 mL/m²).
  • A 10 mL/m² increase in LAVI was associated with a 4.4% increase in ESUS probability, even after adjusting for demographics and comorbidities.

Conclusions:

  • Patients with ESUS exhibit larger left atrial volumes compared to those with non-cardioembolic strokes.
  • Increased left atrial size is an independent risk factor for ESUS, suggesting atrial cardiopathy plays a role.
  • The findings highlight the importance of assessing atrial size in the workup of ESUS, even in the absence of diagnosed atrial fibrillation.
Abstract

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