Differences in left atrial functionality between individuals with ischemic stroke and healthy controls: a comparative analysis

Introduction Recent findings highlight the critical involvement of atrial cardiomyopathy in the pathophysiology of embolic strokes of unidentified source (ESUS). Newer echocardiographic indices, such as the left atrium (LA) peak reservoir strain (LARS), present promising tools for evaluating left atrial (LA) function and gaining insights into the role of atrial myopathy in this specific patient population. The objective of this study was to compare left atrial strain values between patients with ischemic stroke and healthy individuals. Material/methods This retrospective study was conducted at a tertiary center and included individuals aged 18 to 65 with stroke and no prior history of atrial fibrillation or carotid artery disease who underwent a transesophageal echocardiogram between January 2018 and June 2023. Fifty patients were excluded due to insufficient data. Gender and age-matched healthy individuals were also enrolled. The left atrial strain was quantified using the speckle-tracking method in the apical four-chamber view. Statistical analysis was performed using non-parametric tests (Mann-Whitney test), and the predetermined level of statistical significance was set at p < 0.05. Results A total of 197 patients with stroke were included in the study, comprising 128 men (65.1%) and 83 healthy individuals, of which 52 were men (62.7%). Among the stroke patients, 64 individuals (32.5%) were identified to have a patent foramen ovale (PFO). The median age for both sub-groups of stroke patients (with and without PFO) was 52 years (range 20-65 years), while the healthy individuals had a median age of 49 years (range 19-63 years). The left atrial strain (LARS) values exhibited a statistically significant difference (p=0.032) between the healthy individuals’ group (mean rank 156.5) and the stroke patients group (mean rank 133.8), with higher values observed in the healthy cohort (Figure 1). Within the stroke patient group, those with PFO had significantly elevated LARS values (mean rank 117.25) compared to those without PFO (mean rank 91.63), demonstrating a notable difference with a p-value of 0.003 (Figure 2). Conclusions Our study reveals a noteworthy distinction in left atrial strain (LARS) values between stroke patients and healthy individuals, with stroke patients demonstrating significantly lower LARS values. Additionally, within the stroke group, individuals with a patent foramen ovale (PFO) present higher LARS values compared to those without PFO.