Left Atrial Volumes and Associated Stroke Subtypes

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2013 Oct 22

PMID 24139054

Citations 8

Authors

Quratulain Shaikh

Bilal Ahmed

Maryam Ahmed

Jamal Hussain Mahar

Masood Ahmad

Ayesha Ahmed

Farzin Majeed

Fariha Sadiq Ali

Maria Khan

Ayeesha Kamran Kamal

Affiliations

Soon will be listed here.

Abstract

Background: Cardio embolism and cerebrovascular atherosclerosis are two major mechanisms of stroke. Studies investigating associations between advanced echocardiographic parameters and stroke mechanisms are limited.

Methods: This study is a standardized review of 633 patients admitted to the stroke service of a tertiary care hospital following a standardized stroke investigation and management pathway. Stroke subtypes were characterized using the Causative Classification System, using the hospitals online radiologic archival system with CCS certified stroke investigators. Patients with two mechanisms were excluded.

Results: Patients with cardioembolic stroke had a higher proportion of atrial fibrillation (p < 0.001), acute myocardial infarction (p < 0.001) and ischemic heart disease (p < 0.001). On electrocardiogram (ECG) and transthoracic Echo (TTE), patients with cardioembolic stroke had a greater atrial fibrillation (p < .00), left ventricular thrombus (p < .00), left ventricular ejection fraction <30% (p < .00) and global hypokinesia (p < .00) Patients with cardioembolic stroke had higher mean left atrial volume indices (LAVi) (p < 0.001), mean left ventricular mass indices (LVMi) (p < 0.05) and mean left atrial diameters (LAD) (p < 0.05). At LAVi of 29-33 ml/m2, the risk of atherothrombotic stroke increased. The risk of cardioembolic stroke increased with LAVi of 34 ml/m2 and above.

Conclusion: Left atrial volume indices may be linked to specific stroke phenotype. At mild increases in left atrial dimensions, the risks of atherosclerotic stroke are high, and probably reflect hypertension as the unifying mechanism. Further increases in left atrial dimensions shifts the risk towards cardioembolic stroke.

Citing Articles

The usefulness of global longitudinal peak strain and left atrial volume index in predicting atrial fibrillation in patients with ischemic stroke.

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P-wave indices and left atrial mechanics as predictors of atrial cardiopathy in embolic stroke of undetermined source.

Masood S, Ashraf S, Malik M, Wahab S Sci Rep. 2023; 13(1):19965.

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Left Atrial Dilatation and Reduced Left Ventricular Ejection Fraction Are Associated With Cardioembolic Stroke.

Hosseini Farahabadi M, Milani-Nejad S, Liu S, Yu W, Shafie M Front Neurol. 2021; 12:680651.

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Left atrial size and risk of recurrent ischemic stroke in cardiogenic cerebral embolism.

Quan W, Yang X, Li Y, Li J, Ye W, Zhang O Brain Behav. 2020; 10(10):e01798.

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