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Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients With Stroke
- Source :
- Stroke. 47:1444-1451
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- Background and Purpose— The evaluation of sources of cardioembolism with transesophageal echocardiography (TEE) in patients with stroke is crucial but semi-invasive. We hypothesized that the size and mechanical function of the left atrium (LA) assessed by transthoracic echocardiography (TTE) could provide useful information on high risk of cardioembolism on TEE in patients with stroke. Furthermore, we sought to define the determinants of LA mechanical dysfunction in these patients. Methods— A total of 248 patients with acute ischemic stroke (147 men; 64±13 years) who underwent 2-dimensional and speckle tracking TTE followed by TEE were analyzed. Results— LA appendage emptying velocity, prevalence of LA or LA appendage thrombus, prevalence of aortic plaques, and incidence of embolic stroke showed significant differences among the 4 groups classified according to the median values of the LA volume index and global LA longitudinal strain (LALS). Patients at high risk of cardioembolism evidenced by TEE revealed significantly larger LA volume index and lower global LALS than those without. Global LALS (cutoff, 11.5%; area under the curve, 0.947; sensitivity, 100%; specificity, 91%; P P =0.04) for LA or LA appendage thrombus than LA volume index (cutoff, 36.2 mL/m 2 ; area under the curve, 0.823; sensitivity, 88%; specificity, 75%; P =0.002). Age, left ventricular systolic function, LA volume index, and pulse wave velocity were independent determinants for global LALS. Conclusions— LA mechanical dysfunction is closely associated with high risks of cardioembolism. Global LALS assessed by speckle tracking TTE well discriminates the presence of LA or LA appendage thrombus on TEE in patients with acute ischemic stroke.
- Subjects :
- Male
Aging
medicine.medical_specialty
Heart Diseases
Atrial Appendage
Pulse Wave Analysis
030204 cardiovascular system & hematology
Ventricular Function, Left
Brain Ischemia
03 medical and health sciences
0302 clinical medicine
Internal medicine
Prevalence
medicine
Humans
In patient
Thrombus
Pulse wave velocity
Stroke
Aged
Advanced and Specialized Nursing
business.industry
Coronary Thrombosis
Incidence
Incidence (epidemiology)
Area under the curve
Middle Aged
medicine.disease
Thrombosis
Plaque, Atherosclerotic
Echocardiography
Cardiology
Atrial Function, Left
Female
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Echocardiography, Transesophageal
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15244628 and 00392499
- Volume :
- 47
- Database :
- OpenAIRE
- Journal :
- Stroke
- Accession number :
- edsair.doi.dedup.....ac69fef3d9e992c8ac28f9d34f23efea