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Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Value of Cardiac Structural Metrics in Identifying Cardioembolic Stroke: A Cross-Sectional Study
Guojuan Chen1,2,3, Ling Ling1,2, Peng Ding4
1Department of Neurology, TianjinHuanhu Hospital, Tianjin, China.
Insights
Left atrial diameter (LAD) effectively identifies cardioembolic stroke, even without atrial fibrillation (AF). These cardiac measurements aid in stroke cause determination during acute phases.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Detecting paroxysmal atrial fibrillation (AF) in acute ischemic stroke is difficult.
- Identifying cardioembolic stroke etiology is crucial for appropriate management.
- Cardiac structural metrics from echocardiography may offer diagnostic value.
Purpose of the Study:
- To evaluate the diagnostic utility of cardiac structural metrics for cardioembolic stroke.
- To assess the predictive performance of echocardiographic measurements in identifying stroke etiology.
Main Methods:
- A single-center cohort study included 1357 patients with ischemic stroke.
- Transthoracic echocardiography was performed within 7 days of stroke onset.
- Key measurements included left atrial diameter (LAD), right atrial diameter (RAD), and interventricular septal thickness (IVSd).
Main Results:
- 101 patients (7.4%) had cardioembolic stroke.
- LAD, RAD, and IVSd were independently associated with cardioembolic stroke.
- LAD showed the highest discriminative ability (AUC 0.744), outperforming RAD and IVSd.
Conclusions:
- Left atrial diameter (LAD) is a significant predictor of cardioembolic stroke, irrespective of AF status.
- Cardiac structural metrics, especially LAD, can assist in etiologic subtyping of acute ischemic stroke.
- Echocardiographic findings provide valuable insights for stroke diagnosis and management.
Objectives:
Paroxysmal atrial fibrillation (AF) is often challenging to detect in the acute phase of ischemic stroke. This study aimed to assess the diagnostic value of readily available cardiac structural metrics in identifying cardioembolic stroke etiology.
Methods:
In a single-center cohort study, we enrolled patients who underwent transthoracic echocardiography within 7 days of stroke onset. We measured the left atrium diameter (LAD), right atrium diameter (RAD), left ventricular internal diameter, right ventricular internal diameter, interventricular septal thickness at end-diastole (IVSd), left ventricular posterior wall thickness, and assessed for mitral and aortic regurgitation. The predictive performance of these metrics for cardioembolic stroke was evaluated by calculating the area under the receiver operating characteristic curve (AUC).
Results:
Among the 1357 enrolled patients, 101 (7.4%) were diagnosed with cardioembolic stroke. After adjusting for potential confounders, LAD, RAD, and IVSd remained independently associated with cardioembolic stroke in both the full population and in patients without AF. LAD demonstrated the highest discriminative ability, with an AUC of 0.744 (95% CI: 0.682-0.806). The AUCs for RAD and IVSd were 0.583 (0.510-0.657) and 0.584 (0.516-0.652), respectively.
Conclusions:
LAD is a good predictor for identifying cardioembolic stroke, independent of AF status. Cardiac structural metrics, particularly LAD, may aid in etiologic subtyping during the acute phase of ischemic stroke.
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