Does left atrial strain imaging accurately identify cardio-embolic stroke in diabetic patients with acute ischemic stroke?
Left atrial strain imaging, particularly PALS, maintains strong diagnostic accuracy for identifying cardio-embolic stroke even in diabetic patients who typically have baseline atrial remodeling.
Atrial strain imaging has emerged as a promising marker of atrial cardiomyopathy and a potential tool for identifying cardio-embolic (CE) stroke. However, its diagnostic performance in diabetic patients, who frequently exhibit atrial remodeling and diastolic dysfunction, remains uncertain. To assess the diagnostic value of atrial strain parameters in identifying cardio-embolic stroke among diabetic patients with acute ischemic stroke (AIS). We conducted a prospective bicentric study between October 2023 and March 2024 in the Neurology Department of Habib Bourguiba University Hospital and the Cardiology Department of Hedi Chaker University Hospital, Sfax. We consecutively recruited 204 adult patients admitted for acute ischemic stroke. 189 patients were retained for analysis. All patients were in sinus rhythm on a 12-lead ECG. Parameters of atrial cardiomyopathy were systematically assessed, particularly left atrial strain: PALS (peak atrial longitudinal strian: reservoir function), PACS (peak atrial conduit strian: contractile function), and LAcS (conduit function). Among the 189 included patients, 45 (23.8%) were diagnosed with paroxysmal atrial fibrillation, 114 (60.3%) had non-cardio-embolic strokes, and 30 (15.9%) had cryptogenic strokes. Atrial strain parameters were significantly lower in patients with cardio-embolic stroke ( p < 0.001). The area under the curve (AUC) for PALS in detecting CE stroke was 0.841. In the diabetic subgroup (n = 70, 37% of the cohort), strain values remained significantly decreased in patients with CE stroke (n = 12) compared to those with non-CE stroke (n = 49). PALS was 23.70 ± 7.39 vs. 30.77 ± 9.51 ( p = 0.002, AUC = 0.80), PACS was 13.66 ± 5.83 vs. 16.87 ± 5.71 ( p = 0.019, AUC = 0.734), and LAcS was 10.04 ± 3.68 vs. 14.16 ± 6.22 ( p = 0.009, AUC = 0.771). Despite the structural and metabolic alterations commonly observed in diabetes, atrial strain, particularly reservoir function assessed by PALS, retains a strong discriminative value for identifying cardio-embolic stroke.
Haddar et al. (Thu,) studied this question.
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