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Left Atrial Strain, Embolic Stroke of Undetermined Source, and Atrial Fibrillation Detection
  • +15
  • Zubair Bashir,
  • Edward W. Chen,
  • Shuyuan Wang,
  • Liqi Shu,
  • Eric D. Goldstein,
  • Maheen Rana,
  • Narendra Kala,
  • Xing Dai,
  • Daniel Mandel,
  • Phinnara Has,
  • Mingxing Xie,
  • Tao Wang,
  • John Dickey,
  • Athena Poppas,
  • James Simmons,
  • Christopher Song,
  • Shadi Yaghi,
  • Philip Haines
Zubair Bashir
Brown University Warren Alpert Medical School
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Edward W. Chen
Brown University Warren Alpert Medical School
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Shuyuan Wang
Huazhong University of Science and Technology Tongji Medical College
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Liqi Shu
Brown University Department of Neurology
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Eric D. Goldstein
Brown University Department of Neurology
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Maheen Rana
Brown University Department of Neurology
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Narendra Kala
Brown University Department of Neurology
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Xing Dai
Brown University Department of Neurology
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Daniel Mandel
Brown University Department of Neurology
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Phinnara Has
Rhode Island Hospital
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Mingxing Xie
Huazhong University of Science and Technology Tongji Medical College
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Tao Wang
Stanford Cardiovascular Institute
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John Dickey
University of Massachusetts Chan Medical School Division of Cardiovascular Medicine
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Athena Poppas
Brown University Warren Alpert Medical School
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James Simmons
Brown University Warren Alpert Medical School
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Christopher Song
Brown University Warren Alpert Medical School
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Shadi Yaghi
Brown University Department of Neurology
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Philip Haines
Brown University Warren Alpert Medical School

Corresponding Author:[email protected]

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Abstract

Background: Atrial cardiopathy is a proposed mechanism of embolic stroke of undetermined source (ESUS). Left atrial (LA) strain may identify early atrial cardiopathy prior to structural changes. We aim to study the associations between LA strain, ESUS, and atrial fibrillation (AF) detection in ESUS. Methods: The study population included patients with ESUS and non-cardioembolic (NCE) stroke presenting to statewide stroke center between January 2016 and June 2017 who underwent transthoracic echocardiography. Speckle tracking echocardiography (STE) was used to measure the 3 phases of LA strain (reservoir, conduit, and contractile). Binary logistic regression analysis was performed to determine the associations between LA strain and stroke subtype (ESUS vs. NCE) as well as follow-up detection of AF in ESUS patients. Results: We identified 656 patients, 307 with ESUS and 349 with NCE. In binary logistic regression, the lowest tertiles of LA reservoir (adjusted OR 1.944, 95% CI 1.266-2.986, p = 0.002), contractile (aOR 1.568, 95% CI 1.035-2.374, p = 0.034), and conduit strain (aOR 2.288, 95% CI 1.448-3.613, p = 0.001) were more likely to be significantly associated with ESUS compared to NCE stroke. Among all ESUS patients, the lowest tertiles of LA reservoir strain (OR 2.534, 95% CI 1.029-6.236, p = 0.043), contractile strain (OR 2.828, 95% CI 1.158-6.903, p = 0.022), and conduit strain (OR 2.614, 95% CI 1.003-6.815, p = 0.049) were significantly associated with subsequent detection of AF. Conclusion: Reduced LA strain is associated with ESUS occurrence and AF detection in ESUS patients. Therefore, quantification of LA strain in ESUS patients may improve risk stratification and guide secondary prevention strategies.
27 Jul 2023Submitted to Echocardiography
27 Jul 2023Submission Checks Completed
27 Jul 2023Assigned to Editor
07 Aug 2023Reviewer(s) Assigned
07 Oct 2023Review(s) Completed, Editorial Evaluation Pending