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

 Darae Kim  ;  Chi Young Shim  ;  Geu-Ru Hong  ;  Mi-Hyun Kim  ;  Jiwon Seo  ;  In Jeong Cho  ;  Young Dae Kim  ;  Hyuk-Jae Chang  ;  Jong-Won Ha  ;  Ji Hoe Heo  ;  Namsik Chung 
 Stroke, Vol.47(6) : 1444-1451, 2016 
Journal Title
Issue Date
Aged ; Aging ; Atrial Appendage/diagnostic imaging ; Atrial Appendage/physiopathology ; Atrial Function, Left* ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/physiopathology ; Coronary Thrombosis/complications ; Coronary Thrombosis/diagnostic imaging ; Coronary Thrombosis/physiopathology ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Diseases/complications ; Heart Diseases/diagnostic imaging ; Heart Diseases/physiopathology* ; Humans ; Incidence ; Male ; Middle Aged ; Plaque, Atherosclerotic/diagnostic imaging ; Plaque, Atherosclerotic/physiopathology ; Prevalence ; Pulse Wave Analysis ; Stroke/complications ; Stroke/diagnostic imaging ; Stroke/physiopathology* ; Ventricular Function, Left
atrial appendage ; echocardiography, transesophageal ; heart atria ; pulse wave analysis ; stroke ; thrombosis
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
김다래(Kim, Da Rae)
김미현(Kim, Mi Hyun)
김영대(Kim, Young Dae) ORCID logo https://orcid.org/0000-0001-5750-2616
서지원(Seo, Jiwon) ORCID logo https://orcid.org/0000-0002-7641-3739
심지영(Shim, Chi Young) ORCID logo https://orcid.org/0000-0002-6136-0136
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
정남식(Chung, Nam Sik)
조인정(Cho, In Jeong)
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
허지회(Heo, Ji Hoe) ORCID logo https://orcid.org/0000-0001-9898-3321
홍그루(Hong, Geu Ru) ORCID logo https://orcid.org/0000-0003-4981-3304
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