Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients with Stroke

Darae Kim, ChiYoung Shim, Geu Ru Hong, Mi Hyun Kim, Jiwon Seo, In Jeong Cho, Young Dae Kim, Hyuk-Jae Chang, Jong Won Ha, Jihoe Heo, Namsik Chung

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background and Purpose - The evaluation of sources of cardioembolism with transesophageal echocardiography (TEE) in patients with stroke is crucial but semi-invasive. We hypothesized that the size and mechanical function of the left atrium (LA) assessed by transthoracic echocardiography (TTE) could provide useful information on high risk of cardioembolism on TEE in patients with stroke. Furthermore, we sought to define the determinants of LA mechanical dysfunction in these patients. Methods - A total of 248 patients with acute ischemic stroke (147 men; 64±13 years) who underwent 2-dimensional and speckle tracking TTE followed by TEE were analyzed. Results - LA appendage emptying velocity, prevalence of LA or LA appendage thrombus, prevalence of aortic plaques, and incidence of embolic stroke showed significant differences among the 4 groups classified according to the median values of the LA volume index and global LA longitudinal strain (LALS). Patients at high risk of cardioembolism evidenced by TEE revealed significantly larger LA volume index and lower global LALS than those without. Global LALS (cutoff, 11.5%; area under the curve, 0.947; sensitivity, 100%; specificity, 91%; P<0.001) revealed a significantly better diagnostic power (P=0.04) for LA or LA appendage thrombus than LA volume index (cutoff, 36.2 mL/m 2 ; area under the curve, 0.823; sensitivity, 88%; specificity, 75%; P=0.002). Age, left ventricular systolic function, LA volume index, and pulse wave velocity were independent determinants for global LALS. Conclusions - LA mechanical dysfunction is closely associated with high risks of cardioembolism. Global LALS assessed by speckle tracking TTE well discriminates the presence of LA or LA appendage thrombus on TEE in patients with acute ischemic stroke.

Original languageEnglish
Pages (from-to)1444-1451
Number of pages8
JournalStroke
Volume47
Issue number6
DOIs
Publication statusPublished - 2016 Jun 1

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Heart Atria
Stroke
Transesophageal Echocardiography
Atrial Appendage
Echocardiography
Thrombosis
Area Under Curve
Pulse Wave Analysis
Left Ventricular Function

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Kim, Darae ; Shim, ChiYoung ; Hong, Geu Ru ; Kim, Mi Hyun ; Seo, Jiwon ; Cho, In Jeong ; Kim, Young Dae ; Chang, Hyuk-Jae ; Ha, Jong Won ; Heo, Jihoe ; Chung, Namsik. / Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients with Stroke. In: Stroke. 2016 ; Vol. 47, No. 6. pp. 1444-1451.
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abstract = "Background and Purpose - The evaluation of sources of cardioembolism with transesophageal echocardiography (TEE) in patients with stroke is crucial but semi-invasive. We hypothesized that the size and mechanical function of the left atrium (LA) assessed by transthoracic echocardiography (TTE) could provide useful information on high risk of cardioembolism on TEE in patients with stroke. Furthermore, we sought to define the determinants of LA mechanical dysfunction in these patients. Methods - A total of 248 patients with acute ischemic stroke (147 men; 64±13 years) who underwent 2-dimensional and speckle tracking TTE followed by TEE were analyzed. Results - LA appendage emptying velocity, prevalence of LA or LA appendage thrombus, prevalence of aortic plaques, and incidence of embolic stroke showed significant differences among the 4 groups classified according to the median values of the LA volume index and global LA longitudinal strain (LALS). Patients at high risk of cardioembolism evidenced by TEE revealed significantly larger LA volume index and lower global LALS than those without. Global LALS (cutoff, 11.5{\%}; area under the curve, 0.947; sensitivity, 100{\%}; specificity, 91{\%}; P<0.001) revealed a significantly better diagnostic power (P=0.04) for LA or LA appendage thrombus than LA volume index (cutoff, 36.2 mL/m 2 ; area under the curve, 0.823; sensitivity, 88{\%}; specificity, 75{\%}; P=0.002). Age, left ventricular systolic function, LA volume index, and pulse wave velocity were independent determinants for global LALS. Conclusions - LA mechanical dysfunction is closely associated with high risks of cardioembolism. Global LALS assessed by speckle tracking TTE well discriminates the presence of LA or LA appendage thrombus on TEE in patients with acute ischemic stroke.",
author = "Darae Kim and ChiYoung Shim and Hong, {Geu Ru} and Kim, {Mi Hyun} and Jiwon Seo and Cho, {In Jeong} and Kim, {Young Dae} and Hyuk-Jae Chang and Ha, {Jong Won} and Jihoe Heo and Namsik Chung",
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Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients with Stroke. / Kim, Darae; Shim, ChiYoung; Hong, Geu Ru; Kim, Mi Hyun; Seo, Jiwon; Cho, In Jeong; Kim, Young Dae; Chang, Hyuk-Jae; Ha, Jong Won; Heo, Jihoe; Chung, Namsik.

In: Stroke, Vol. 47, No. 6, 01.06.2016, p. 1444-1451.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients with Stroke

AU - Kim, Darae

AU - Shim, ChiYoung

AU - Hong, Geu Ru

AU - Kim, Mi Hyun

AU - Seo, Jiwon

AU - Cho, In Jeong

AU - Kim, Young Dae

AU - Chang, Hyuk-Jae

AU - Ha, Jong Won

AU - Heo, Jihoe

AU - Chung, Namsik

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background and Purpose - The evaluation of sources of cardioembolism with transesophageal echocardiography (TEE) in patients with stroke is crucial but semi-invasive. We hypothesized that the size and mechanical function of the left atrium (LA) assessed by transthoracic echocardiography (TTE) could provide useful information on high risk of cardioembolism on TEE in patients with stroke. Furthermore, we sought to define the determinants of LA mechanical dysfunction in these patients. Methods - A total of 248 patients with acute ischemic stroke (147 men; 64±13 years) who underwent 2-dimensional and speckle tracking TTE followed by TEE were analyzed. Results - LA appendage emptying velocity, prevalence of LA or LA appendage thrombus, prevalence of aortic plaques, and incidence of embolic stroke showed significant differences among the 4 groups classified according to the median values of the LA volume index and global LA longitudinal strain (LALS). Patients at high risk of cardioembolism evidenced by TEE revealed significantly larger LA volume index and lower global LALS than those without. Global LALS (cutoff, 11.5%; area under the curve, 0.947; sensitivity, 100%; specificity, 91%; P<0.001) revealed a significantly better diagnostic power (P=0.04) for LA or LA appendage thrombus than LA volume index (cutoff, 36.2 mL/m 2 ; area under the curve, 0.823; sensitivity, 88%; specificity, 75%; P=0.002). Age, left ventricular systolic function, LA volume index, and pulse wave velocity were independent determinants for global LALS. Conclusions - LA mechanical dysfunction is closely associated with high risks of cardioembolism. Global LALS assessed by speckle tracking TTE well discriminates the presence of LA or LA appendage thrombus on TEE in patients with acute ischemic stroke.

AB - Background and Purpose - The evaluation of sources of cardioembolism with transesophageal echocardiography (TEE) in patients with stroke is crucial but semi-invasive. We hypothesized that the size and mechanical function of the left atrium (LA) assessed by transthoracic echocardiography (TTE) could provide useful information on high risk of cardioembolism on TEE in patients with stroke. Furthermore, we sought to define the determinants of LA mechanical dysfunction in these patients. Methods - A total of 248 patients with acute ischemic stroke (147 men; 64±13 years) who underwent 2-dimensional and speckle tracking TTE followed by TEE were analyzed. Results - LA appendage emptying velocity, prevalence of LA or LA appendage thrombus, prevalence of aortic plaques, and incidence of embolic stroke showed significant differences among the 4 groups classified according to the median values of the LA volume index and global LA longitudinal strain (LALS). Patients at high risk of cardioembolism evidenced by TEE revealed significantly larger LA volume index and lower global LALS than those without. Global LALS (cutoff, 11.5%; area under the curve, 0.947; sensitivity, 100%; specificity, 91%; P<0.001) revealed a significantly better diagnostic power (P=0.04) for LA or LA appendage thrombus than LA volume index (cutoff, 36.2 mL/m 2 ; area under the curve, 0.823; sensitivity, 88%; specificity, 75%; P=0.002). Age, left ventricular systolic function, LA volume index, and pulse wave velocity were independent determinants for global LALS. Conclusions - LA mechanical dysfunction is closely associated with high risks of cardioembolism. Global LALS assessed by speckle tracking TTE well discriminates the presence of LA or LA appendage thrombus on TEE in patients with acute ischemic stroke.

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