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  • Online Resource  (5)
  • Bashir, Zubair  (5)
  • Haines, Philip  (5)
  • Rana, Maheen  (5)
  • Song, Christopher  (5)
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  • Online Resource  (5)
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  • 1
    Online Resource
    Online Resource
    Left atrial strain, embolic stroke of undetermined source, and atrial fibrillation detection
    Wiley ; 2024
    In:  Echocardiography Vol. 41, No. 1 ( 2024-01)
    Details
    In: Echocardiography, Wiley, Vol. 41, No. 1 ( 2024-01)
    Abstract: Atrial cardiopathy is a proposed mechanism of embolic stroke of undetermined source (ESUS). Left atrial (LA) strain may identify early atrial cardiopathy prior to structural changes. We aim to study the associations between LA strain, ESUS, and atrial fibrillation (AF) detection in ESUS. Methods The study population included patients with ESUS and noncardioembolic (NCE) stroke presenting to the Rhode Island Hospital Stroke Center between January 2016 and June 2017 who underwent transthoracic echocardiography. Speckle tracking echocardiography (STE) was used to measure the three phases of LA strain (reservoir, conduit, and contractile). Binary logistic regression analysis was performed to determine the associations between LA strain and stroke subtype (ESUS vs. NCE) as well as follow‐up detection of AF in ESUS patients. Results We identified 656 patients, 307 with ESUS and 349 with NCE. In binary logistic regression, the lowest tertiles of LA reservoir (adjusted OR 1.944, 95% CI 1.266–2.986, p  = .002), contractile (aOR 1.568, 95% CI 1.035–2.374, p  = .034), and conduit strain (aOR 2.288, 95% CI 1.448–3.613, p  = .001) were more likely to be significantly associated with ESUS compared to NCE stroke. Among all ESUS patients, the lowest tertiles of LA reservoir strain (OR 2.534, 95% CI 1.029–6.236, p  = .043), contractile strain (OR 2.828, 95% CI 1.158–6.903, p  = .022), and conduit strain (OR 2.614, 95% CI 1.003–6.815, p  = .049) were significantly associated with subsequent detection of AF. Conclusion Reduced LA strain is associated with ESUS occurrence and AF detection in ESUS patients. Therefore, quantification of LA strain in ESUS patients may improve risk stratification and guide secondary prevention strategies.
    Type of Medium: Online Resource
    ISSN: 0742-2822 , 1540-8175
    URL: Issue
    URL: Article
    DOI: 10.1111/echo.v41.1
    DOI: 10.1111/echo.15738
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2041033-5
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  • 2
    Online Resource
    Online Resource
    Abstract TP101: Reduced Left Atrial Strain In Embolic Stroke Of Undetermined Source Is Associated With Atrial Fibrillation Detected On Mobile Cardiac Monitoring
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Recent studies have failed to reveal benefit of anticoagulation over antiplatelet therapy in the prevention of recurrent stroke in Embolic Stroke of Undetermined Source (ESUS) patients. This is attributed to significant heterogeneity in underlying mechanisms of ESUS. Atrial fibrillation (AF) is a potential cause of ESUS, and evaluating left atrial (LA) function by measuring LA strain by speckle tracking echocardiography (STE) is an emerging technique to assess LA biomechanics. Our study investigates the relationship between LA strain and AF detection in ESUS patients. We included hospitalized patients with ESUS subtype who underwent STE. LA function by assessing three phases of LA strain (reservoir, conduit and contractile) were retrospectively quantified and evaluated. Several patients were discharged with mobile cardiac telemetry that was retrospectively reviewed for AF detection. Descriptive statistical methods and both unadjusted and adjusted regression models were used. Among 325 ESUS patients, mean age was 66.5±15.0, 49% were male, 49% had outpatient cardiac monitoring, and 25% had AF detected. LA reservoir (25.17±13.4 vs 32.43±18.13), LA contractile (11.95±9.66 vs 16.67±10.94) and LA conduit (13.08±6.47 vs 17.20±12.21) strains were significantly lower in patients with AF detected compared to patients without AF detected. In the unadjusted binary logistic regression analysis, patients with AF detected had significantly lower LA reservoir (OR 0.967, 95% CI 0.941-0.994), LA contractile (OR 0.957, 95% CI 0.918-0.997) and LA conduit (OR 0.961, 95% CI 0.925-0.998) strains. This significance was lost after adjusting for age. Our study demonstrates that reduced LA strain is associated with subsequent detection of AF in ESUS patients. We believe that routine LA strain measurement can aid clinicians in identifying ESUS patients with high AF prevalence and thereby appropriately target patients for anticoagulation therapy to prevent subsequent strokes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.TP101
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Abstract WP182: Diastolic Dysfunction With Elevated Left Ventricular Filling Pressures Is Associated With Embolic Stroke Of Undetermined Source And Atrial Fibrillation Detection After Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Introduction: Diastolic dysfunction, particularly with elevated left ventricle filling pressure (LVFP) is known to be a strong independent predictor of all-cause mortality and major cardiac events. There is limited data on the role of diastolic function in ischemic stroke. We hypothesize that diastolic dysfunction with elevated LVFP is more likely to be present in patients with Embolic stroke of undetermined source (ESUS) compared to non-cardioembolic stroke and is associated with AF on cardiac monitoring in the ESUS group. Methods: This is a single center retrospective study that included adult patients with a diagnosis of acute ischemic stroke from 2014 to 2016. We excluded patients with confirmed cardioembolic stroke and those with indeterminate diastolic function. ESUS was defined as no ipsilateral stenoses ≥ 50%, cardiac telemetry for at least two weeks without evidence of atrial fibrillation or atrial flutter, and a LVEF ≥ 30%. A transthoracic echocardiogram was performed and interpreted by cardiologists. Baseline patient characteristics and clinical variables were compared among patients with and without diastolic dysfunction. Potential associations between diastolic dysfunction, ESUS and AF detection in ESUS patients were assessed using logistic regression. Results: There were 509 patients, the mean age was 64.19, 54.81% were male, and 146 had LVFP data. Diastolic dysfunction overall was not associated with ESUS (adjusted OR 1.44, 95% CI 0.91-2.28, p = 0.125) or AF detection on cardiac monitoring (adjusted OR 1.87, 95% CI 0.75-4.70, p = 0.183). However, diastolic dysfunction and elevated LVFP was associated with ESUS subtype (adjusted OR 2.26, 95% CI 1.03-4.93, p = 0.041) and AF detection on cardiac monitoring (adjusted OR 3.58, 95% CI 1.07-12.01, p = 0.039). Conclusion: Our study suggests that diastolic dysfunction with elevated LVFP is associated with ESUS stroke subtype and AF detection on cardiac monitoring. Therefore, the presence of diastolic dysfunction with elevated LVFP may identify a population of stroke patients more likely to have ESUS, particularly in the setting of occult AF. Studies are needed to confirm our findings and test the safety and efficacy of anticoagulation in patients with ESUS and diastolic dysfunction with elevated LVFP.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.WP182
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Abstract WP111: Reduced Left Atrial Strain Is More Common In Embolic Stroke Of Undetermined Source Compared To Non Cardioembolic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Atrial fibrosis, a determinant of atrial cardiopathy, is seen more commonly in ESUS as compared to non-cardioembolic stroke patients and precedes changes in atrial dimension. We utilized speckle tracking echocardiography (STE) to identify atrial cardiopathy and to investigate the association between LA strain and ESUS compared to NCE stroke. Hospitalized patients with ESUS and NCE stroke subtypes who underwent in-hospital STE were included. Three phases of LA strain (reservoir, conduit, and contractile) were retrospectively calculated. Binary logistic regression analyses using LA strain as a continuous variable and as tertiles were performed to determine the association between different phases of LA strain and stroke subtypes (ESUS vs NCE). Among 680 total stroke patients, 355 were classified as NCE and 325 as ESUS. LA reservoir strain (36.3 ± 18.3 vs. 31.5 ± 17.8), LA contractile strain (17.4 ± 11.1 vs. 15.4 ± 10.4), and LA conduit strain (19.0 ± 11.9 vs. 16.7 ± 11.7) differed significantly between NCE and ESUS stroke subtypes. The fully adjusted binary logistic regression revealed that the lowest tertile of LA reservoir (OR 2.378, 95% CI 1.538-3.676), contractile (OR 1.555, 95% CI 1.032-2.342), and conduit strain (OR 2.009, 95% CI 1.293-3.124) was more likely to be associated with ESUS compared to NCE stroke. When using strain as continuous variables, LA reservoir (OR 0.987, 95% CI 0.977-0.997) and conduit strain (OR 0.980, 95% CI 0.965-0.996) were significantly reduced in ESUS compared to NCE. Our study demonstrates that reduced LA strain is more strongly associated with ESUS compared to NCE stroke subtype. We believe that atrial cardiopathy carries mechanistic significance and measuring LA strain may become a critical imaging biomarker in ESUS stroke prognostication.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.WP111
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Abstract 13027: Reduced Left Atrial Strain is More Common in Embolic Stroke of Undetermined Source Compared to Non-Cardioembolic Stroke and Can Predict Atrial Fibrillation on Outpatient Cardiac Monitoring
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Embolic stroke of undetermined source (ESUS) accounts for 20% of all ischemic strokes with at least 30% having biomarkers of atrial cardiopathy. Traditional parameters of left atrial (LA) structure and function (particularly Left Atrial Volume Index) are similar in ESUS and non-cardioembolic (NCE) stroke subtypes. LA strain measured by speckle tracking echocardiography (STE) is an emerging non-invasive technique to assess LA structure, function, and biomechanics. Our study evaluates whether LA strain differs between patients with ESUS and NCE and whether LA strain magnitude predicts diagnosis of atrial fibrillation (AF) in ESUS. Hospitalized patients with ESUS and NCE stroke subtypes who underwent in-hospital echocardiography were included. STE was performed, and three phases of LA strain (reservoir, conduit, and contractile) were measured. Binary logistic regression analyses were performed to determine the association between different phases of LA strain and stroke subtypes (ESUS vs NCE) as well as AF detection in ESUS patients. A total of 685 patients met the inclusion criteria. Mean age was 65 years; 55% were men; 49% of strokes were NCE; and 51% were ESUS. In patients with ESUS, 57% (189/330) underwent cardiac monitoring. AF was detected in 17.4% (33/189). In fully adjusted binary logistic regression analysis, patients with ESUS had lower LA reservoir strain (adjusted OR 0.99, 95% CI 0.98-0.99, p = 0.039) and LA contractile strain (adjusted OR 0.98, 95% CI 0.97-1.00, p = 0.089). Furthermore, lower LA reservoir strain was associated with AF detection in ESUS patients (OR 0.96, 95% CI 0.93-0.99, p = 0.028). In conclusion, all phases of LA strain were reduced in ESUS compared to NCE. This suggests the presence of atrial cardiopathy in ESUS stroke patients. Furthermore, atrial strain was significantly reduced in ESUS patients found to have AF. These findings may carry mechanistic significance in stroke development and AF detection in ESUS patients.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.13027
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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