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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
08:10

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Association of Left Atrial Echocardiographic Indices With Atrial Fibrillation in Cryptogenic Stroke: A Systematic

Bernadus Bernardino Bramantyo1, Paulina Lusty Artanti2, Gabriela Queensanya Lienardy3

  • 1Department of Cardiology and Vascular Medicine, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.

Echocardiography (Mount Kisco, N.Y.)
|May 21, 2026
PubMed

Insights

Atrial fibrillation (AF) detection after cryptogenic stroke (CS) is linked to enlarged left atrial volume index (LAVI) and reduced left atrial reservoir strain (LASr) and contractile strain (LASct). These left atrial indices may predict new-onset AF in CS survivors.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Atrial fibrillation (AF) is a significant cause of cardioembolism and cryptogenic stroke (CS).
  • Left atrial (LA) indices are explored as potential markers for detecting asymptomatic AF in CS survivors.
  • Understanding the relationship between LA function and new-onset AF is crucial for stroke management.

Purpose of the Study:

  • To evaluate the association between left atrial (LA) indices and the incidence of newly detected atrial fibrillation (AF) in patients who have experienced cryptogenic stroke (CS).
  • To compare LA indices, including left atrial volume index (LAVI), left atrial reservoir strain (LASr), and left atrial contractile strain (LASct), between CS patients with and without new-onset AF.

Main Methods:

  • A systematic literature search was conducted across major databases (PubMed, Scopus, Cochrane Library, Europe PMC).
  • Observational studies of CS patients without prior AF who were monitored for AF detection were included.
  • Meta-analysis pooled echocardiographic LA indices (LAVI, LASr, LASct) comparing patients who developed new-onset AF versus those who did not, including a subgroup analysis for embolic stroke of undetermined source (ESUS).

Main Results:

  • The meta-analysis included 23 studies with 3475 participants, identifying 1050 with new-onset AF.
  • CS patients who developed new-onset AF exhibited significantly higher LAVI (MD 7.76 mL/m²; p < 0.00001) and significantly lower LASr (MD -8.07%; p < 0.00001) and LASct (MD -5.26%; p < 0.00001) compared to those without new AF.
  • Similar significant differences in LAVI, LASr, and LASct were observed in the ESUS subgroup.

Conclusions:

  • New-onset AF in CS patients is associated with distinct left atrial structural and functional changes, specifically higher LAVI and reduced LASr and LASct.
  • These findings suggest that LA indices derived from echocardiography can serve as valuable indicators for predicting the likelihood of developing AF after a cryptogenic stroke.
  • Further research into LA function may improve risk stratification and therapeutic strategies for CS patients at risk of AF.
Abstract

Keywords:
atrial fibrillationcryptogenic strokeechocardiographyembolic stroke of undetermined sourceleft atrial strain

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