Affiliation:
1. Department of Cardiology Alpert Medical School of Brown University Providence Rhode Island USA
2. Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA
3. Department of Ultrasound Tongji Medical College Huazhong University of Science and Technology Wuhan China
4. Department of Neurology Alpert Medical School of Brown University Providence Rhode Island USA
5. Lifespan Biostatistics, Epidemiology and Research Design Rhode Island Hospital Providence Rhode Island USA
6. Stanford Cardiovascular Institute Stanford University Palo Alto California USA
7. Division of Cardiovascular Medicine Department of Medicine University of Massachusetts Medical School Worcestor Massachusetts USA
8. Department of Pulmonary, Critical Care, and Sleep Medicine Alpert Medical School of Brown University Providence Rhode Island USA
Abstract
AbstractBackgroundAtrial cardiopathy is a proposed mechanism of embolic stroke of undetermined source (ESUS). Left atrial (LA) strain may identify early atrial cardiopathy prior to structural changes. We aim to study the associations between LA strain, ESUS, and atrial fibrillation (AF) detection in ESUS.MethodsThe study population included patients with ESUS and noncardioembolic (NCE) stroke presenting to the Rhode Island Hospital Stroke Center between January 2016 and June 2017 who underwent transthoracic echocardiography. Speckle tracking echocardiography (STE) was used to measure the three phases of LA strain (reservoir, conduit, and contractile). Binary logistic regression analysis was performed to determine the associations between LA strain and stroke subtype (ESUS vs. NCE) as well as follow‐up detection of AF in ESUS patients.ResultsWe identified 656 patients, 307 with ESUS and 349 with NCE. In binary logistic regression, the lowest tertiles of LA reservoir (adjusted OR 1.944, 95% CI 1.266–2.986, p = .002), contractile (aOR 1.568, 95% CI 1.035–2.374, p = .034), and conduit strain (aOR 2.288, 95% CI 1.448–3.613, p = .001) were more likely to be significantly associated with ESUS compared to NCE stroke. Among all ESUS patients, the lowest tertiles of LA reservoir strain (OR 2.534, 95% CI 1.029–6.236, p = .043), contractile strain (OR 2.828, 95% CI 1.158–6.903, p = .022), and conduit strain (OR 2.614, 95% CI 1.003–6.815, p = .049) were significantly associated with subsequent detection of AF.ConclusionReduced LA strain is associated with ESUS occurrence and AF detection in ESUS patients. Therefore, quantification of LA strain in ESUS patients may improve risk stratification and guide secondary prevention strategies.