Left Atrial Function Is Impaired in Some Patients With Stroke of Undetermined Etiology: Potential Implications for Evaluation and Therapy

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• 作者：Laura Sanchis^a ; ^{lsanchisruiz@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Silvia Montserrat^a ; Ví ; ctor Obach^b ; Á ; lvaro Cervera^b ; Á ; ngel Chamorro^b ; Bà ; rbara Vidal^a ; Aleksandra Mas-Stachurska^a ; Bart Bijnens^c ; Marta Sitges^a
• 关键词：Left atrial strain ; Undetermined etiology stroke ; Ischemic stroke ; Cardiogenic stroke ; Speckle tracking
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：69
• 期：7
• 页码：650-656
• 全文大小：643 K

文摘

Stroke etiology remains undetermined in up to 30% of cases. Paroxysmal atrial fibrillation is found in 20% to 28% of patients with stroke initially classified as being of undetermined etiology. The aim of our study was to analyze left atrial function in ischemic stroke patients to identify patterns associated with cardioembolic etiology and to determine whether the patterns identified can be found in individuals initially classified as having a stroke of undetermined etiology.

Methods

We studied a cohort of in-hospital ischemic stroke patients referred for transthoracic echocardiography. Treating neurologists determined stroke etiology based on the TOAST classification. Left atrial contractile function was assessed using 2-dimensional echocardiography to determine their ejection fraction and speckle tracking to measure left atrial strain rate: a-wave. Left atrial function was compared between stroke etiology subgroups and healthy controls.

Results

Ninety-seven patients (aged 67 ± 15 years) with ischemic stroke (16.5% large-artery atherosclerosis, 15.5% small-vessel occlusion, 11.3% cardioembolic, 5.1% other determined etiology, 51.1% undetermined etiology) and 10 healthy volunteers (aged 63 ± 7 years) were included. Left atrial ejection fraction was significantly decreased only in patients with stroke of cardioembolic and undetermined etiology compared with the control group (31.5 ± 17.2%, 40.2 ± 17.1%, and 59.1 ± 8.4%, respectively; P = .004). The left atrial strain rate was significantly lower in patients with stroke caused by cardioembolic or undetermined etiology, or large-artery atherosclerosis compared with controls (−0.86 ± 0.49, −1.31 ± 0.56, −1.5 ± 0.47, −2.37 ± 1.18, respectively; P < .001).

Conclusions

Patients with stroke of undetermined etiology with left atrial function (ejection fraction and strain) similar to that of cardioembolic stroke patients may be misclassified and could potentially benefit from prolonged electrocardiography monitoring. Left atrial function analysis (ejection fraction and strain) might help to identify potential cardioembolic sources in patients with stroke of undetermined etiology.