Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Echocardiography. 2024 Jan;41(1):e15738. doi: 10.1111/echo.15738.
Atrial 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.
The 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.
We 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.
Reduced 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.
心房心肌病是不明来源栓塞性卒中（ESUS）的一种潜在机制。左心房（LA）应变可能在结构改变之前识别早期心房心肌病。我们旨在研究 LA 应变、ESUS 和 ESUS 中房性颤动（AF）检测之间的相关性。
研究人群包括 2016 年 1 月至 2017 年 6 月在罗德岛医院卒中中心就诊的 ESUS 和非心源性（NCE）卒中患者，他们接受了经胸超声心动图检查。斑点追踪超声心动图（STE）用于测量 LA 应变的三个阶段（储器、传导和收缩）。二元逻辑回归分析用于确定 LA 应变与卒中亚型（ESUS 与 NCE）之间的相关性，以及 ESUS 患者随访时 AF 的检测。
我们共纳入 656 例患者，其中 307 例为 ESUS，349 例为 NCE。在二元逻辑回归中，LA 储器应变最低三分位数（调整后 OR 1.944，95%CI 1.266-2.986，p=0.002）、收缩应变（aOR 1.568，95%CI 1.035-2.374，p=0.034）和传导应变（aOR 2.288，95%CI 1.448-3.613，p=0.001）与 ESUS 较 NCE 卒中更显著相关。在所有 ESUS 患者中，LA 储器应变最低三分位数（OR 2.534，95%CI 1.029-6.236，p=0.043）、收缩应变（OR 2.828，95%CI 1.158-6.903，p=0.022）和传导应变（OR 2.614，95%CI 1.003-6.815，p=0.049）与 ESUS 患者中 AF 的后续检测显著相关。
LA 应变降低与 ESUS 发生和 ESUS 患者 AF 检测相关。因此，ESUS 患者 LA 应变的定量可能会改善风险分层并指导二级预防策略。
