Diagnostic and Prognostic Value of Left Atrial Function in Identification of Cardioembolism and Prediction of Outcomes in Patients with Cryptogenic Stroke

Bhat, A.; Chen, Henry H.L.; Khanna, S.; Mahajan, Vipul; Gupta, Arnav; Burdusel, Camelia; Wolfe, Nigel; Lee, Lina; Gan, G.; Dobbins, Timothy; MacIntyre, C. Raina; Tan, Timothy C.

doi:10.1016/j.echo.2022.05.018

Cited by 15 publications

(11 citation statements)

References 38 publications

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“…Previous studies have shown a correlation between enlarged LA chamber size with adverse cardiovascular outcomes including strokes and arrhythmias 29,30 . Our study demonstrates a significant inverse relationship between LA reservoir strain and ESUS compared to NCE, further potentiating previously reported associations between LA strain and cryptogenic stroke 13,19 . In addition to LA reservoir strain, our study also shows that reduced LA conduit and contractile strains are significantly associated with ESUS compared to NCE stroke.…”

Section: Discussionsupporting

confidence: 85%

“…29,30 Our study demonstrates a significant inverse relationship between LA reservoir strain and ESUS compared to NCE, further potentiating previously reported associations between LA strain and cryptogenic stroke. 13,19 In addition to LA reservoir strain, our study also shows that reduced LA conduit and contractile strains are significantly associated with ESUS compared to NCE stroke. In both ESUS and NCE patients, LA strain was lower compared to mean normal values in healthy subjects, defined as 42.1 ± 10.0, 27.7 ± 9.7, and 14.4 ± 6.3 for LA reservoir, conduit, and contractile, respectively 31 ; however, all phases of LA strain were significantly lower in ESUS patients compared to NCE patients, indicating higher atrial cardiopathy and remodeling.…”

Section: Discussionsupporting

confidence: 51%

“…18 A recent single-center study showed the association of LA strain and stroke subtypes including cryptogenic stroke. 19 The goal of our study is to investigate the relationship between LA strain and stroke, specifically ESUS and NCE stroke subtypes, in a geographically distinct population using a comprehensive stroke database.…”

Section: Introductionmentioning

confidence: 99%

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Left atrial strain, embolic stroke of undetermined source, and atrial fibrillation detection

Bashir,

Chen,

Wang

et al. 2024

Echocardiography

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BackgroundAtrial 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.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 51%

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Left atrial strain, embolic stroke of undetermined source, and atrial fibrillation detection

Bashir,

Chen,

Wang

et al. 2024

Echocardiography

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“…Changes in LA deformation are associated with prognostic implications in several scenarios, such as in the prediction of a cardioembolic event. 58 Furthermore, LA has been the focus of discussions and investigations that reinforce its role in a myriad of cardiovascular situations, including new concepts, such as the definition of atrial failure. 59 Hence, there is a great potential in the use of LA myocardial deformation in the context of analysis of LV DF to improve the accuracy of algorithms employed in clinical practice.…”

Section: Final Considerationsmentioning

confidence: 99%

Left Atrial Strain in the Analysis of LV Diastolic Function: Ready to Use?

Júnior¹,

Assef²,

Braga³

et al. 2023

ABC Imagem Cardiovascular

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Left atrial (LA) dilation is a common indicator of diastolic dysfunction, and its analysis through a volume calculation reflects the cumulative effects of the left ventricular (LV) filling pressures. However, an increase in LA volume is not exclusive to diastolic dysfunction, which has also been observed in other clinical conditions. Thus, the evaluation of the LA strain enables a functional study of this chamber, adding to the morphological analysis through the volume calculation.The LA strain, measured using the speckle tracking technique, brings information on the reservoir, conduction, and contractile functions of the LA, and is related to the LV function. Moreover, the changes in the LA strain precede the volumetric changes by nearly a decade, and correlate inversely with the degree of LA fibrosisthis has an important relationship with the diastolic dysfunction and its grading system. Albeit insufficient to explain its totality, LA fibrosis can partially justify the functional changes of this heart chamber and can favor the use of this variable as a complement to the current protocols for the analysis of the diastolic function.Although further study is still warranted to establish other clinical applications, the LA strain stands out in the analysis of diastolic dysfunction and can be considered ready to use, offering a great potential to improve the evaluation of the overall cardiac function.

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“…Previously, left ventricle global longitudinal strain(LV-GLS) and right ventricle free wall longitudinal strain(RV-FWLS) has been shown to independently predict heart failure or mortality in rTOF. [5] Left atrial strain is a new STE biomarker that has been shown to have prognostic implications in patients with heart failure,[6] cryptogenic stroke, [7] and patients undergoing catheter ablation for atrial brillation.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of left atrial strain in patients with Tetralogy of Fallot

Mutluer

Bowen

Grootel

et al. 2023

Preprint

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PURPOSE: To demonstrate prognostic utility of left atrial strain(LAS) in adult patients with repaired Tetralogy of Fallot(rTOF). METHODS: Adults patients with rTOF were prospectively enrolled in this study between years 2011-2015. Left atrium(LA) phasic functions were assessed using 2D speckle tracking echocardiography(2D-STE). Association of LA strain(LAS) with primary(any cardiovascular event) and secondary(death, heart failure or arrhythmia) composite endpoints was assessed using Cox regression analysis. RESULTS: Hundred-and-twelve rTOF patients, in whom LAS was feasible and were in sinus rhythm, were included in the final analysis (age 33±10 years, 68[61%] male). Median duration of follow-up was 8.6[4.2-9.7] years in the study group. Primary composite endpoint was reached in 48 patients (mean event-free survival time: 7.2[6.6-7.9] years), and secondary composite endpoint was reached in 22 patients (mean event-free survival time: 8.7[8.1-9.2] years). LAS-r was defined as tertile groups(1st tertile<33 %,2nd tertile=33-44%,3rd tertile>44%). Decreasing tertiles of LAS-r was associated with primary and secondary composite endpoints in Kaplan-Meier analysis(p=0.02 and 0.002, respectively). In univariable Cox-regression, both decreasing LAS-r and LAS-r tertiles were associated with primary and secondary composite endpoints. Adjusted by initial repair age and NT-proBNP quartiles, increased LAS-r was associated with significantly decreased occurrence of experiencing any events(HR=0.97,CI:0.93-0.99,p=0.037]). Decreasing LAS-r was still associated with primary endpoint when adjusted by left atrium volume index(LAVImax)(HR=0.96,CI:0.03-0.99,p=0.01),left ventricle global longitudinal strain(LV-GLS)(0.95,95%CI:0.92-0.98,p=0.002) or right ventricle free wall longitudinal strain (RV-FWLS)(0.96,95%CI:0.93-0.99,p=0.04). CONCLUSION: Assessment of LA mechanics with the use of STE has incremental utility in determination of mortality and morbidity in rTOF, and may be implemented in clinical practice.

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Diagnostic and Prognostic Value of Left Atrial Function in Identification of Cardioembolism and Prediction of Outcomes in Patients with Cryptogenic Stroke

Cited by 15 publications

References 38 publications

Left atrial strain, embolic stroke of undetermined source, and atrial fibrillation detection

Left atrial strain, embolic stroke of undetermined source, and atrial fibrillation detection

Left Atrial Strain in the Analysis of LV Diastolic Function: Ready to Use?

Prognostic value of left atrial strain in patients with Tetralogy of Fallot

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