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Updated: Jan 17, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
[The left atrial reservoir strain in ischemic stroke]
Amina Maamri1, Sabrina Denden1, Meriem Mediouni1
1Service de cardiologie hôpital Jacques PUEL, Rodez, France.
Insights
Left atrial reservoir strain below 20% in patients with ischemic stroke or TIA may indicate an embolic source and predict future atrial fibrillation. This finding aids in identifying stroke origins and guiding patient management.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Identifying the cardiac source of ischemic stroke (IS) and transient ischemic attack (TIA) is crucial.
- Atrial fibrillation (AF) is a common cause of cardioembolic IS.
- Left atrial (LA) reservoir strain (RS) analysis using 2D Speckle-Tracking is superior to LA dimensions for predicting paroxysmal AF and IS.
Purpose of the Study:
- To investigate the association between LA reservoir strain (RS) and the embolic origin of IS (cardioembolic vs. ESUS).
- To identify factors associated with IS.
- To explore the relationship between RS and the occurrence of AF, identifying factors linked to impaired RS (<20%).
Main Methods:
- Retrospective observational study of 79 patients hospitalized for IS or TIA with no prior AF or anticoagulation.
- Analysis of LA function using 2D Speckle-Tracking to measure reservoir strain (RS).
- Correlation of RS values with stroke etiology and AF occurrence during follow-up.
Main Results:
- A significant association was found between RS < 20% and the embolic origin of IS (excluding PFO), with P=0.01.
- An RS < 20% was linked to the subsequent occurrence of atrial fibrillation during follow-up (P=0.04).
- The median RS was 27%, with 86% of patients exhibiting RS < 39%.
Conclusions:
- Reduced LA reservoir strain (<20%) in the acute phase of IS/TIA may suggest an embolic stroke etiology.
- This finding can help predict the occurrence of atrial fibrillation during follow-up in patients without a prior AF history.
- LA reservoir strain is a valuable parameter for assessing embolic stroke risk and AF development.
Background:
The search for a potential cardiac source is a fundamental step in the urgent evaluation of an ischaemic stroke (IS) or Transient ischemic attack (TIA). The most common cardioembolic cause of IS is atrial fibrillation (AF). Analysis of the left atrial function is superior to left atrial (LA) dimensions measurements as predictor of paroxysmal AF, especially with the study of deformation anomalies using 2D Speckle-Tracking. Alteration of the reservoir strain (RS) of the LA is associated with the incidence of IS.
Methods:
Retrospective observational study in patients hospitalised in the neurology departement from January 2022 to April 2023, for IS or TIA, with no history of AF nor anticoagulation treatment. The objectives of the study were to investigate 1) an association between RS and the embolic origin (cardio-embolic and ESUS) of IS, identifying factors associated with IS; 2) an association between RS and the occurrence of atrial fibrillation, identifying factors associated with impaired RS < 20%.
Results:
The study included 79 patients (56% men, median age 72 years), 39% of ischemic strokes were cryptogenic (of which 26% were transient), 23% were cardioembolic, and 14% were embolic of undetermined origin (ESUS). Among the cardioembolic causes (18 patients), 33% were secondary to atrial fibrillation, 39% to a patent foramen ovale (PFO). The median RS was 27%, and the RS was < 39% in 86% of cases, whether the left atrium was dilated or not. With a threshold of 20% and a P value of 0.01, the RS was associated with the embolic origin of the ischemic stroke (PFO group excluded). An RS < 20% was associated with the occurrence of atrial fibrillation during follow-up (P= 0.04).
Conclusion:
Our study suggests that a reservoir strain of the left atrium < 20% during the acute phase of an ischemic stroke/transient ischemic attack, in patients without a history of atrial fibrillation or anticoagulant treatment, may be associated with an embolic origin of the ischemic stroke and the occurrence of atrial fibrillation during follow-up.
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