Introduction: Left atrial (LA) and left atrial appendage (LAA) anatomical remodeling and functional impairment are related to stroke incidence. The prognostic significance of LA and LAA remodeling in stroke patients remains unknown. This study examines the associations of echocardiographic markers of LA and LAA, including 2D speckle tracking echocardiography (STE) strain analysis, with stroke-related outcomes.
Methods: We analyzed data from 71 patients who presented with stroke and were part of the Johns Hopkins Stroke Registry (2013-2015). All patients underwent TTE and TEE and LA area, E, E/A, E/e’, LAA strain, LAA inflow/outflow velocities, presence of spontaneous echo contrast (SEC) and thrombus in LA or LAA were evaluated. Peak systolic LAA strain was calculated utilizing STE from TEE studies (figure). We examined the association of these parameters with 1-year stroke recurrence and 2-year mortality using multivariable logistic regression and Cox-proportional hazards models.
Results: Mean age was (61.5 ± 16.9). The etiology of the stroke was atherosclerotic (42.3%), cardioembolic (35.2%), or small vessel/undetermined (22.5%). Mean LAA strain was -24.02 ± 8.22%. Higher absolute LAA strain values were independently associated with 1-year stroke recurrence (OR 1.2, 95% CI, 1.02-1.40, P<0.05). LA area, age, and prior AF history were independently associated with 2-year mortality, while CHADS2 and CHADS2-VASC were not significant predictors for mortality or stroke recurrence (table).
Conclusions: Increased LA area size independently predicts increased mortality in patients with stroke, and higher peak LAA strain is associated with 1-year stroke recurrence.