Left atrial reservoir strain in ischemic stroke

Abstract

Background

The search for a potential cardiac source is a fundamental step in the urgent evaluation of an ischaemic stroke (IS). The most common cardioembolic cause of IS is atrial fibrillation (AF). Recent studies have demonstrated the superiority of left atrial function versus LA dimensions as a predictor of paroxysmal AF, especially with the study of deformation anomalies using 2D Speckle-Tracking. Alteration of the reservoir strain (RS) of the left atrium (LA) is associated with the incidence of IS.

Objectives

The aims were to identify the association between RS with the embolic origin (cardioembolic and ESUS) of a IS/TIA, as well as the association of RS with the occurrence of AF, in patients with no known AF prior to their stroke nor anticoagulation treatment.

Methods

This is a retrospective observational study in patients hospitalised at the neurology service for IS or transitor (TIA) from January 2022 to April 2023, with no history of AF nor anticoagulation treatment and ho had had transthoracic echocardiography (TTE). We compared embolic (cardioembolic and ESUS) groupe versus non embolic and left reservoir strain < 20% groupe versus > 20% groupe.

Results

79 patients were included, 56% of whom were men, with an median age of 72 years. The mean RS was 27% and the RS was < 39% in 86% of cases. 39% of strokes were Cryptogenic (of which 26% were TIA), 23% Cardio-embolic, 14% ESUS. Among the cardioembolic causes (18 patients): 33% were secondary to AF, 39% to PFO, 16% to severe LV dysfunction. With a threshold of 20% and p value 0.012, the RS demonstrate a significant association with embolic stroke (group PFO excluded). RS < 20% was significantly associated with the occurence of AF with P-value 0.040.

Conclusion

Our study found that a left atrial reservoir strain < 20%, measured on echocardiography, in the acute phase of an IS, in patients with no history of AF or anticoagulant treatment.