Zhang Yanjuan, Jiao Jincheng, Wang Yingying, Liu Sheng, Cao Yuezhou, Shi Haibing, Chen Minglong, Li Mingfang
Division of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
Division of Geriatrics, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
Ann Noninvasive Electrocardiol. 2025 May;30(3):e70093. doi: 10.1111/anec.70093.
To evaluate left atrial (LA) function in patients with embolic stroke of undetermined source (ESUS) and other subtypes of acute ischemic stroke (AIS) related to large-vessel occlusion (LVO).
Consecutive patients with LVO-related AIS were prospectively enrolled from July 2019 to August 2022. To compare LA function with ESUS patients, a control group without prior stroke was sex- and age-matched with ESUS patients in a 1:1 ratio. LA strain was measured within 3 days after stroke. Multivariable logistic regression analysis was performed to assess associations between LA function and stroke subtypes.
This study included 126 patients (mean age 67.7 ± 12.3 year, 39.7% women). Of these, 28 patients met the diagnostic criteria for ESUS, while the remaining were classified as large artery atherosclerosis (n = 49) and non-valvular AF-related cardioembolic stroke (n = 49). Patients with ESUS had lower left atrial reservoir strain (LASr) and left atrial conduit strain (LAScd) compared to those with large artery atherosclerosis (27.8 ± 7.1% vs. 32.0 ± 5.3%, p = 0.004, and 14.3 ± 3.8% vs. 17.3 ± 4.6%, p = 0.005, respectively) and the control group (27.8 ± 7.1% vs. 37.6 ± 7.2%, p < 0.001 and 14.3 ± 3.8% vs. 21.5 ± 7.9%, p < 0.001, respectively). A 5% reduction in LASr and LAScd was associated with a 1.92- and 2.45-fold increase, respectively, in the likelihood of having ESUS compared to large artery atherosclerosis. Lower LASr and LAScd in ESUS patients were prone to be associated with a higher likelihood of cardiovascular events during follow-up.
LA strain is associated with ESUS in stroke patients with LVO. Further studies are needed to explore its utility in identifying specific stroke etiologies.
评估不明来源栓塞性卒中（ESUS）患者以及与大血管闭塞（LVO）相关的其他急性缺血性卒中（AIS）亚型患者的左心房（LA）功能。
前瞻性纳入2019年7月至2022年8月期间连续的LVO相关AIS患者。为了将LA功能与ESUS患者进行比较，一个无既往卒中的对照组按1:1比例与ESUS患者进行性别和年龄匹配。在卒中后3天内测量LA应变。进行多变量逻辑回归分析以评估LA功能与卒中亚型之间的关联。
本研究纳入了126例患者（平均年龄67.7±12.3岁，女性占39.7%）。其中，28例患者符合ESUS诊断标准，其余患者分为大动脉粥样硬化（n = 49）和非瓣膜性房颤相关的心源性栓塞性卒中（n = 49）。与大动脉粥样硬化患者相比，ESUS患者的左心房储存应变（LASr）和左心房管道应变（LAScd）更低（分别为27.8±7.1%对32.0±5.3%，p = 0.004，以及14.3±3.8%对17.3±4.6%，p = 0.005），与对照组相比也更低（分别为27.8±7.1%对37.6±7.2%，p < 0.001，以及14.3±3.8%对21.5±7.9%，p < 0.001）。与大动脉粥样硬化相比，LASr和LAScd降低5%分别与ESUS发生可能性增加1.92倍和2.45倍相关。ESUS患者较低的LASr和LAScd在随访期间更容易与心血管事件的更高可能性相关。
LA应变与LVO卒中患者的ESUS相关。需要进一步研究以探索其在识别特定卒中病因方面的效用。
