Assessment of Left Atrial Global Longitudinal Strain in Patients With Cerebrovascular Ischemic Accidents and No Evidence of Atrial Fibrillation

Document Type : Original Article

Authors

Department of Cardiology, Dr Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Cardioembolic strokes cause more severe disabilities than other subtypes of ischemic strokes. Considering that thrombus formation predominantly occurs in the left atrium (LA), the structure and function of the LA may cause a risk for embolic strokes even in the absence of atrial fibrillation (AF). We hypothesized that functional and structural LA alterations could be associated with acute ischemic strokes regardless of AF occurrence and history.
Methods: This comparative cross-sectional study assessed 40 patients with cerebrovascular accidents (CVA) and 40 healthy controls. We included patients aged above 18 years with ischemic CVA within the preceding 6 months and without AF rhythm. Global longitudinal strain (GLS) was calculated using 2D speckle-tracking echocardiography.
Results: Significant differences existed between the 2 groups regarding the mean values of LAA4C GLS (P=0.01), LAA3C GLS (P=0.002), LAA2C GLS (P=0.002), LA TOTAL GLS (P=0.001), LVA4C GLS (P=0.01), and LV TOTAL GLS (P=0.04). Nevertheless, no significant differences existed in the LA area, LA diameter, EF, LVEDV, LVESV, LVA3C GLS, and LVA2C GLS between the groups.
Conclusions: Our findings suggested the possible involvement of LA morphofunctional dysfunction in CVA events in patients with sinus rhythm. (Iranian Heart Journal 2023; 24(2): 77-83)

Keywords


  1. Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology. 2021; 20(10):795-820.
  2. Bogiatzi C, Hackam DG, McLeod AI, Spence JD. Secular trends in ischemic stroke subtypes and stroke risk factors. Stroke. 2014;45(11):3208-13.
  3. Lin H-J, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, et al. Stroke severity in atrial fibrillation: the Framingham Study. Stroke. 1996;27(10):1760-4.
  4. Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases. 2015;3(5):418-29.
  5. Kamel H, Bartz TM, Longstreth WT, Elkind MSV, Gottdiener J, Kizer JR, et al. Cardiac mechanics and incident ischemic stroke: the Cardiovascular Health Study. Scientific Reports. 2021;11(1):17358.
  6. Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Cryptogenic Stroke. Circulation Research. 2017;120(3):527-40.
  7. Yaghi S, Song C, Gray WA, Furie KL, Elkind MS, Kamel H. Left Atrial Appendage Function and Stroke Risk. Stroke. 2015;46(12):3554-9.
  8. Nagarajarao HS, Penman AD, Taylor HA, Mosley TH, Butler K, Skelton TN, et al. The predictive value of left atrial size for incident ischemic stroke and all-cause mortality in African Americans: the Atherosclerosis Risk in Communities (ARIC) Study. Stroke. 2008;39(10):2701-6.
  9. Tsang TS, Barnes ME, Bailey KR, Leibson CL, Montgomery SC, Takemoto Y, et al. Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc. 2001;76(5):467-75.
  10. Taniguchi N, Miyasaka Y, Suwa Y, Harada S, Nakai E, Kawazoe K, et al. Usefulness of Left Atrial Volume as an Independent Predictor of Development of Heart Failure in Patients With Atrial Fibrillation. Am J Cardiol. 2019;124(9):1430-5.
  11. Shin HY, Jeong IH, Kang CK, Shin DJ, Park HM, Park KH, et al. Relation between left atrial enlargement and stroke subtypes in acute ischemic stroke patients. J Cerebrovasc Endovasc Neurosurg. 2013;15(3):131-6.
  12. Cuspidi C, Carugo S, Tadic M. Looking at the best indexing method of left atrial volume in the hypertensive setting. Hypertension Research. 2021;44(6):722-4.
  13. Bianco F, De Caterina R, Chandra A, Aquila I, Claggett B, Johansen MC, et al. Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS. J Am Heart Assoc. 2022; 11(9):e024292.
  14. Vieira MJ, Teixeira R, Gonçalves L, Gersh BJ. Left atrial mechanics: echocardiographic assessment and clinical implications. Journal of the American Society of Echocardiography. 2014; 27(5):463-78.
  15. Sonaglioni A, Vincenti A, Baravelli M, Rigamonti E, Tagliabue E, Bassi P, et al. Prognostic value of global left atrial peak strain in patients with acute ischemic stroke and no evidence of atrial fibrillation. Int J Cardiovasc Imaging. 2019; 35(4):603-13.
  16. Benjamin EJ, D'Agostino RB, Belanger AJ, Wolf PA, Levy D. Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation. 1995; 92(4):835-41.
  17. Di Tullio MR, Sacco RL, Sciacca RR, Homma S. Left atrial size and the risk of ischemic stroke in an ethnically mixed population. Stroke. 1999; 30(10):2019-24.
  18. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol. 2006; 47(12):2357-63.
  19. Karabay CY, Zehir R, Güler A, Oduncu V, Kalayci A, Aung SM, et al. Left atrial deformation parameters predict left atrial appendage function and thrombus in patients in sinus rhythm with suspected cardioembolic stroke: a speckle tracking and transesophageal echocardiography study. Echocardiography. 2013; 30(5):572-81.
  20. Leong DP, Joyce E, Debonnaire P, Katsanos S, Holman ER, Schalij MJ, et al. Left Atrial Dysfunction in the Pathogenesis of Cryptogenic Stroke: Novel Insights from Speckle-Tracking Echocardiography. J Am Soc Echocardiogr. 2017;30(1):71-9.e1.
  21. Park JH, Hwang IC, Park JJ, Park JB, Cho GY. Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm. J Am Heart Assoc. 2021;10(13):e020414.
  22. Goncalves A, Hung C-L, Claggett B, Nochioka K, Cheng S, Kitzman DW, et al. Left atrial structure and function across the spectrum of cardiovascular risk in the elderly: the atherosclerosis risk in communities study. Circulation: Cardiovascular Imaging. 2016;9(2):e004010.
  23. Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L, et al. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. European Heart Journal-Cardiovascular Imaging. 2018; 19(6):630-8.