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Left atrial mechanics for secondary prevention from embolic stroke of undetermined source

Leyla Elif Sade1, Suzan Keskin1, Ufuk Can2

  • 1Cardiology Department, University of Baskent, 54. sokak E blok No: 45 Bahcelievler, 06490 Ankara, Turkey.

European Heart Journal. Cardiovascular Imaging
|November 18, 2020
PubMed

Insights

Left atrial remodelling, measured by LA strain, can identify patients with embolic stroke of undetermined source (ESUS) even without detected atrial fibrillation. This echocardiographic assessment aids in secondary stroke prevention strategies.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Anticoagulation is crucial for stroke prevention in atrial fibrillation (AF) patients.
  • Identifying AF in cryptogenic stroke (CS) patients is essential for appropriate treatment.
  • Embolic stroke of undetermined source (ESUS) poses a diagnostic challenge without clear AF detection.

Purpose of the Study:

  • To investigate the association between left atrial (LA) remodelling and ESUS.
  • To determine if LA strain can predict AF in CS patients.
  • To evaluate the utility of LA strain in identifying ESUS.

Main Methods:

  • Prospective study of 186 patients with acute ischemic stroke and controls.
  • Continuous ECG monitoring for paroxysmal AF detection, repeated after 12 months if initially undetected.
  • Quantification of LA reservoir strain (LASr) and LA contraction strain (LASct) using speckle-tracking echocardiography.

Main Results:

  • CS patients were divided into AF (n=39) and ESUS (n=58) groups.
  • ESUS patients showed significantly worse LA strain metrics compared to other cause and control groups, despite no detected AF.
  • LASr independently predicted CS and ESUS, outperforming traditional scores like CHA2DS2-VASc.

Conclusions:

  • Echocardiographic assessment of LA remodelling, particularly LASr, is valuable for identifying ESUS.
  • LA strain analysis offers potential for secondary prevention in ESUS patients.
  • Quantifying LA remodelling can aid in risk stratification and treatment decisions for stroke patients.
Abstract

Keywords:
atrial fibrillationechocardiographyleft atriumstrainstroke

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