Left atrial function index in embolic stroke of undetermined source: A case-control study

Abstract

Background & Objectives: Previous studies showed left atrial volume index (LAVi) is a precise surrogate of atrial cardiopathy and associated with new-onset atrial fibrillation and embolic stroke undetermined source (ESUS). Recent data suggest that the left atrial functional index (LAFi) is associated with the risk of developing AF recurrence. However, there was no study to show LAFi in ESUS. We aim to compare the performance of different surrogates of atrial cardiopathy (LAVi and LAFi) in a cohort of ESUS patients and healthy adults. Methods: Between Dec 2018 to Feb 2020, consecutive patients diagnosed with ESUS and normal healthy controls (>18 years) were included. Left atrial diameter (LAD), left atrial diameter index (LADi), LAVi and LAFi were measured by transthoracic echocardiogram under American Society of Echocardiography guidelines. Results: A total of 125 patients (43 controls and 82 ESUS patients) were compared. Significant differences of LADi, LAVi, and LAFi were detected between ESUS and control (p=0.04, p=0.002, and p=0.001, respectively). On adjustment for age, sex, hypertension, and diabetes mellitus, LADi and LAVi the association with ESUS and LAFi (aOR decrease, 0.928; 95% CI 0.882–0.976; p = 0.004) remained significant and LAD, LADi, and LAVi were not associated with ESUS in this analysis. Conclusions: LAFi may be a more comprehensive predictor of atrial cardiopathy as compared to LADi and LAVi in risk stratification of ESUS or cryptogenic stroke.

The effect of rivaroxaban vs aspirin on stroke recurrence among patients with history of cryptogenic stroke and left atrial cardiomyopathy: An analytical cross-sectional study

“…Nonetheless, recent studies, such as Saadatnia et al showed a correlation between atrial pathology markers and ischemic stroke, and suggested that the tissue substrate, rather than the arrhythmic state, could be the most important trigger of stroke risk. 9 Our results are not in line with Hart et al They compared a daily dose of 15 mg of rivaroxaban to 100 mg of aspirin for stroke prevention after embolic stroke of undetermined source (ESUS). They concluded rivaroxaban was not superior to aspirin with regard to the prevention of recurrent stroke after an initial embolic stroke of undetermined source and was associated with a higher risk of bleeding.…”

Altered left atrial metrics in patients with cryptogenic stroke: A systematic review and meta‐analysis

“…We initially identified 6897 articles, with 4292 excluded as duplicates and 2402 excluded as nonrelevant based on title and abstract screening. Full text was examined in 200 articles, with 29 fulfilling inclusion criteria for data analysis 6,7,14–40 …”

“…We therefore examined meta‐regression bubble plots and performed an exclusion analysis to identify outlier studies for sources of influence. A number of studies were identified over all meta‐analysis studies, with resolution of heterogeneity observed following their exclusion 6,16,21–23,26,28,30,32,34,35,37,39 . Notably, the majority of outlier studies were observed in studies comparing CS‐ESUS to HC, indicating probable unidentified clinical covariates in patients compared with healthy participants.…”

“…visible outlier studies, and also performed a rigorous exclusion protocol by sequentially leaving out one or more studies from each analysis, in order to identify influential studies for potential sources of variation (Table 4). 6,16,[21][22][23]26,28,30,32,34,35,37,39 Following outlier omission, variability was significantly reduced for all LA metrics, after controlling for age (I 2 < 40% for all variables). Due to the number of outlier studies, potential for pooled effect bias/distortion, reduction in generalizability following exclusion and lack of single obvious cause of outlier status, 13 we maintained these studies within the analysis and performed a thorough exploration for sources of discrepancy.…”

“…A number of studies were identified over all meta-analysis studies, with resolution of heterogeneity observed following their exclusion. 6,16,[21][22][23]26,28,30,32,34,35,37,39 Notably, the majority of outlier studies were observed in studies comparing CS-ESUS to HC, indicating probable unidentified clinical covariates in patients compared with healthy participants. In addition, meta-analysis examining the advanced measurement of LASr had a number of outlier studies which may indicate technical limitations.…”