Left Atrial Dynamics Is Altered in Young Adults With Cryptogenic Ischemic Stroke: A Case‐Control Study Utilizing Advanced Echocardiography

Abstract

Background Ischemic stroke in young individuals often remains cryptogenic. Some of these strokes likely originate from the heart, and atrial fibrosis might be one of the etiological mechanisms. In this pilot study, we investigated whether advanced echocardiography findings of the left atrium ( LA ) of young cryptogenic stroke patients differ from those of stroke‐free controls. Methods and Results We recruited 30 cryptogenic ischemic stroke patients aged 18 to 49 years and 30 age‐ and sex‐matched stroke‐free controls among participants of the SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome) study ( NCT 01934725). We measured basic left ventricular parameters and detailed measures of the LA , including 4‐dimensional volumetry, speckle tracking epsilon, strain rate, and LA appendix orifice variation. Data were compared as continuous parameters and by tertiles. Compared with controls, stroke patients had smaller LA reservoir volumes (10.2 [interquartile range, 5.4] versus 13.2 [5.4] mL ; P =0.030) and smaller positive epsilon values (17.8 [8.5] versus 20.8 [10.1]; P =0.023). In the tertile analysis, stroke patients had significantly lower left atrial appendage orifice variation (3.88 [0.75] versus 4.35 [0.90] mm; P =0.043), lower LA cyclic volume change (9.2 [2.8] versus 12.8 [3.5] mL ; P =0.023), and lower LA contraction peak strain rate (−1.8 [0.6] versus −2.3 [0.6]; P =0.021). We found no statistically significant differences in left ventricular measures. Conclusions This preliminary comparison suggests altered LA dynamics in young patients with cryptogenic ischemic stroke, and thus that LA wall pathology might contribute to these strokes. Our results await confirmation in a larger sample.

Associating cryptogenic ischemic stroke in the young with cardiovascular risk factor phenotypes

“…Our findings should be contrasted to other studies, which found that cryptogenic stroke was similar to CE stroke, most notably when using profiles of differentially expressed genes 14 . In addition, Embolic Stroke of Undetermined Source (ESUS) is being increasingly recognized as an important subset of cryptogenic stroke 8 , 15 , 16 . While our study did not find many cryptogenic strokes that fit the cardiac phenotype, 93 (78.8%) of cryptogenic strokes in our cohort with sufficient work-up met the criteria for ESUS 17 , 18 .…”

Diastolic function in young patients with cryptogenic stroke: A case–control pilot study

“…Detailed baseline data and clinical data and basic left ventricular (LV) measurements have been published earlier (Pirinen et al 2020). Compared with controls, patients were heavier, had a larger waist circumference, higher body-mass index (BMI) and a larger BSA.…”

Right atrium and cryptogenic ischaemic stroke in the young: a case–control study

“…Characteristics of study subjects have been previously published. 6 15 16 None of the patients had PFO closure prior to CMR.…”

“…Recent studies suggest that left atrial (LA) dynamics are altered in cryptogenic stroke. 6 7 Atrial fibrosis and atrial cardiomyopathy have been suggested as possible mechanisms, 8 9 but also PFO with atrial septal aneurysm has been associated with LA dysfunction, suggested to be an additional contributing factor to the mechanism of PFO-related stroke. 10 However, there has been only a little interest on the right atrium (RA) in patients who had a stroke.…”