Abstract 17804: Clinical Implications and Determinants of Left Atrial Longitudinal Strain in Patients with Acute Ischemic Stroke: Mechanistic Insights into Aortic-Ventricular-Atrial Coupling
Introduction: We sought to determine clinical implications of LA longitudinal strain ([[Unable to Display Character: ɛ]]) assessed by 2D speckle tracking echocardiography (STE) for predicting left atrial appendage(LAA) flow stasis or thrombus in patients with acute ischemic stroke (AIS).
Method: A total of 250 patients (147 males, age 64±13) with AIS and sinus rhythm were enrolled from 2012 to 2013. Comprehensive TTE for LV and LA assessment and 2D STE of LA was done, followed by TEE to assess LAA emptying velocity (eV), spontaneous echo contrast (SEC), LA or LAA thrombus, aortic wall thickness (AWT) in descending aorta, and aortic arch atheroma. According to LA volume index (LAVI, cut-off: 28 ml/m2) and LA [[Unable to Display Character: ɛ]] (cut-off: 23 %), patients were divided into 4 groups [Group 1 (n=79), normal LAVI with normal [[Unable to Display Character: ɛ]]; Group 2 (n=55), increased LAVI with normal [[Unable to Display Character: ɛ]]; Group 3 (n=37), normal LAVI with decreased [[Unable to Display Character: ɛ]]; Group 4 (n=79), increased LAVI with decreased [[Unable to Display Character: ɛ]]]. Arterial stiffness was assessed with brachial ankle pulse wave velocity (PWV).
Results: LV longitudinal function (e’ and S’) and LV filling pressure (E/e’) differed significantly among 4 groups. PWV and AWT increased in a stepwise manner. The prevalence of SEC, LAA thrombus, complex aortic arch atheroma showed significant difference (Table). LA ε revealed a better correlation with E’ (r=0.15, p=0.019), S’ (r=0.45, p<0.001), PWV (r=-0.36, p<0.001) and aortic wall thickness (r=-0.29, p<0.001) than LAVI (r=0.05, p=0.440; r=-0.34, p<0.01; r=0.17, p=0.06; r=0.16, p=0.09, respectively). In multiple regression, age, body mass index, S’, and PWV were independent determinants for LA ε, even after adjusting for LAVI. LA ε less than 10.8% showed a good predictive value for decreased LAA eV (<20 cm/s) which is prone to thrombus formation (AUC 0.913, Sen 91%, Spe 80%).
Conclusion: LA [[Unable to Display Character: ɛ]] by 2D STE better predicts LAA flow stasis or thrombus than LAVI. Also, it reflects aortic stiffness and LV longitudinal dysfunction in aspects of aortic-ventricular-atrial coupling in patients with AIS.
Author Disclosures: D. Kim: None. M. Kim: None. I. Cho: None. Y. Kim: None. H. Nam: None. H. Chang: None. G. Hong: None. J. Ha: None. N. Chung: None. C. Shim: None.
- © 2014 by American Heart Association, Inc.