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Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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Cryptogenic stroke, left atrial function, and atrial fibrillation: a complex relationship.

Francesca Augusta Gabrielli1, Gianluigi Bencardino2, Antonio Di Renzo3

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Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|September 2, 2025
PubMed
Summary

Left atrial volume index (LAVi) and LA strain (LASct) measured by echocardiography can predict atrial fibrillation (AF) in embolic stroke of undetermined source (ESUS) patients. These metrics may help select patients who will benefit from loop recorder monitoring for AF detection.

Keywords:
Atrial fibrillationImplantable loop-recorderSpeckle tracking echocardiographyStroke

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Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Paroxysmal atrial fibrillation (AF) is a potential cause of embolic strokes of undetermined source (ESUS).
  • Loop recorders (LRs) detect AF but widespread use in ESUS patients may not be cost-effective.
  • Assessing left atrial (LA) function via speckle tracking echocardiography (STE) could identify ESUS patients likely to benefit from LR monitoring.

Purpose of the Study:

  • To evaluate if LA function assessed by STE can identify ESUS patients who would benefit from LR monitoring for AF detection.
  • To determine the predictive value of LA function parameters for AF occurrence in ESUS patients.

Main Methods:

  • Consecutive ESUS patients undergoing LR implantation and echocardiography (including STE) between 2020-2023 were enrolled.
  • Patients were grouped based on AF detection by LR during a median 10.0-month follow-up.
  • Left atrial volume index (LAVi) and LA longitudinal strain (LASr, LASct) were measured using STE.

Main Results:

  • 64 patients were included: 27 (42.2%) with AF and 37 (57.8%) without AF.
  • The AF group had significantly higher LAVi (44.7 vs. 34.4 mL/m²) and lower LASr (19.7% vs. 27.4%) and LASct (7.4% vs. 12.4%) compared to the No-AF group.
  • Multivariable analysis identified LAVi and LASct as independent predictors of AF.

Conclusions:

  • Left atrial volume index (LAVi) and LA contraction strain (LASct) are reliable predictors of AF in ESUS patients.
  • These echocardiographic parameters may help in selecting ESUS patients who are most likely to benefit from loop recorder implantation for AF detection.