Left atrial reservoir strain >26% identified embolic stroke of undetermined source with 86% sensitivity and 92% specificity (AUC 0.915; 95% CI 0.86-0.97; P<0.0001).
Observational (n=149)
Does echocardiographic assessment of left atrial strain identify embolic stroke of undetermined source in patients with acute ischemic stroke?
Left atrial reservoir strain assessed by speckle-tracking echocardiography accurately identifies patients with embolic stroke of undetermined source and predicts incident atrial fibrillation.
Effect estimate: AUC 0.915 (95% CI 0.86-0.97)
p-value: p=<0.0001
AIMS: Anticoagulation is not justified unless atrial fibrillation (AF) is detected in cryptogenic stroke (CS) patients. We sought to explore whether left atrial (LA) remodelling is associated with embolic stroke of undetermined source (ESUS). METHODS AND RESULTS: In this prospective study, we evaluated consecutively 186 patients in sinus rhythm who presented with an acute ischaemic stroke (embolic and non-embolic) and sex- and age-matched controls. We performed continuous electrocardiogram (ECG) monitoring to capture paroxysmal AF episodes as recommended by the guidelines. After 12 months of follow-up, continuous ECG monitoring was repeated in patients with undetected AF episodes. We quantified LA reservoir and contraction strain (LASr and LASct) by speckle-tracking, LA volumes by 3D echocardiography. Out of 186 patients, 149 were enrolled after comprehensive investigation for the source of ischaemic stroke and divided into other cause (OC) (n = 52) and CS (n = 97) groups. CS patients were also subdivided into AF (n = 39) and ESUS (n = 58) groups. Among CS patients, LA strain predicted AF independently from CHARGE-AF score and LA volume indices. ESUS group, despite no captured AF, had significantly worse LA metrics than OC and control groups. AF group had the worst LA metrics. Moreover, LASr predicted both CS (embolic stroke with and without AF) and ESUS (embolic stroke with no detected AF) independently from LAVImax and CHA2DS2-VASc score. LASr >26% yielded 86% sensitivity, 92% specificity, 92% positive, and 86% negative predictive values for the identification of ESUS (areas under curve: 0.915, P < 0.0001, 95% confidence interval: 0.86-0.97). CONCLUSION: Echocardiographic quantification of LA remodelling has great potential for secondary prevention from ESUS.
Sade et al. (Tue,) conducted a observational in Acute ischaemic stroke (cryptogenic stroke / ESUS) (n=149). Left atrial reservoir strain (LASr) assessment vs. Other cause stroke and controls was evaluated on Identification of ESUS (AUC 0.915, 95% CI 0.86-0.97, p=<0.0001). Left atrial reservoir strain >26% identified embolic stroke of undetermined source with 86% sensitivity and 92% specificity (AUC 0.915; 95% CI 0.86-0.97; P<0.0001).