Differential Associations Between Left Atrial Volume Parameters and Ischemic Stroke Subtypes

Aim: An increase in left atrial diameter (LAD) is commonly used to differentiate cardioembolic stroke from other ischemic stroke subtypes. We investigated whether echocardiographic volume-indexed parameters beyond the routinely used LAD could also be used to differentiate cardioembolic from atherothrombotic ischemic stroke. Methods: In this single-center retrospective cross-sectional study, 74 patients with confirmed ischemic stroke were classified as having cardioembolic (n=33) or atherothrombotic stroke (n=41) based on neuroimaging, clinical assessment, and cardiac rhythm monitoring. Baseline demographics, National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) outcomes, and echocardiographic measurements—including left atrial diameter/height (LAD/H), left atrial diameter/body surface area (LAD/BSA), left atrial volume index (LAVi), interventricular septal thickness, and left ventricular (LV) posterior wall thickness—were recorded. Receiver operating characteristic curve analysis was conducted to assess the discriminative performance of left atrial (LA) parameters. Results: The cardioembolic group demonstrated significantly higher NIHSS scores and worse follow-up mRS outcomes compared with the atherothrombotic group (p=0.011). Echocardiography revealed elevated values of LAD (p<0.001), LAD/H (p<0.001), LAD/BSA (p=0.004), and LAVi (p=0.004) in patients with cardioembolic stroke, while interventricular septum and LV posterior wall thicknesses showed no significant intergroup differences. Receiver operating characteristic analysis identified LAVi, LAD/H, LAD/BSA, and LAD as significant discriminators. Optimal thresholds included LAVi >42 mL/m², LAD/BSA >21.59 mm/m², and LAD/H >0.23 mm/cm. Pairwise comparisons showed no significant differences between LAD and these echocardiographic markers in discriminating cardioembolic from atherothrombotic stroke (p>0.05). Conclusion: Indexed LA measurements, particularly LAVi, LAD/H, and LAD/BSA enhance discrimination between cardioembolic and atherothrombotic stroke and may improve routine echocardiographic evaluation.