Relationship between left atrial volume by transthoracic echocardiography and cerebrovascular stroke in patients with sinus rhythm and preserved systolic function

Background The left atrial volume is a marker of atrial myopathy and has been associated with ischemic stroke in atrial fibrillation. Although left atrial volume-stroke association in sinus rhythm (SR) has been studied, evidence remains limited as current stroke prevention protocols predominantly rely on atrial fibrillation-specific risk scores, such as CHA₂DS₂-VA, leaving a gap in stroke risk stratification for patients in SR. Aim This study aims to highlight the potential utility of the left atrial volume index (LAVi) in stroke risk stratification for SR patients with preserved left ventricular systolic function (LVSF), a population that is typically underrepresented in current stroke prevention protocols. Patients and methods This observational study included 50 individuals with acute ischemic stroke referred for transthoracic echocardiography. Results LAVi was significantly associated with ischemic stroke risk, with hypertension, prior stroke, and obesity identified as key risk factors. Among women with acute ischemic stroke, 75% had hypertension and 54.2% had a previous stroke, with a mean weight of 84.50±15.31 kg. The mean LAVi increased with the severity of left ventricular diastolic dysfunction ( P =0.040). Univariate analysis showed that sex and weight were significant and retained their significance in multivariate analysis, while hypertension and prior stroke lost significance in multivariate analysis, potentially due to confounding variables. Conclusion LAVi may be a key stroke risk marker in SR patients with preserved left ventricular systolic function especially women and obese individuals. Larger studies and longitudinal follow-ups are needed to confirm its role in stroke prevention.