Document Type : Review Article
Authors
1 Echocardiography Department, Chamran Cardiovascular Medical and Research Hospital and Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Sciences, Isfahan, Iran
2 Echocardiography Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
3 Associate Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Stroke is one of the primary causes of morbidity and mortality worldwide, including a large proportion
of cryptogenic strokes. Long-term electrocardiographic monitoring is beneficial in prospective studies for
detecting atrial fibrillation in patients with cryptogenic stroke. This review aimed to evaluate the advanced
echocardiographic parameters and their roles in assessing left atrial (LA) function in the incidence of
cryptogenic and ischemic strokes. Main resources, including PubMed, Scopus, and ISI Web of Science
databases, were evaluated for articles published in English from 2010 until May 2021. LA echocardiographic
parameters such as LA strain and strain rate, isovolumetric relaxation time (IVRT), the mean left atrial
volume index (LAVI), LA reservoir volume, systole strain rate (SSR) of left atrial appendage, and lack of
LA function response to maximal exercise as measured by the LA ejection fraction during rest and exercise
could be considered for assessing the risk of cryptogenic strokes and ischemic strokes. The results indicated
that increased LA volumes and reduced LA strain rate were correlated with cryptogenic stroke. Advanced
parameters of LA function, measured by speckle tracking echocardiography, such as strain and strain
rate values in different parts of the cardiac cycle, in addition to standard measures of LA function such
as LA ejection fraction and LAVI, will define an excellent understanding regarding LA myopathy and risk
assessment of cryptogenic stroke, independent of considering conventional cardiovascular risk factors.
Highlights
The PubMed and Google Scholar links for Azam Soleimani.
Keywords
- Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112(8):1142-7.
- Thrall G, Lane D, Carroll D, Lip GY. Quality of life in patients with atrial fibrillation: a systematic review. Am J Med. 2006;119(5):448.e1-19.
- Morillo CA, Banerjee A, Perel P, Wood D, Jouven X. Atrial fibrillation: the current epidemic. J Geriatr Cardiol. 2017;14(3):195-203.
- Yiin GS, Howard DP, Paul NL, Li L, Luengo-Fernandez R, Bull LM, et al. Age-specific incidence, outcome, cost, and projected future burden of atrial fibrillation-related embolic vascular events: a population-based study. Circulation. 2014;130(15):1236-44.
- Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760-4.
- Arboix A, García-Eroles L, Massons JB, Oliveres M, Pujades R, Targa C. Atrial fibrillation and stroke: clinical presentation of cardioembolic versus atherothrombotic infarction. Int J Cardiol. 2000;73(1):33-42.
- Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837-47.
- Rivner H, Mitrani RD, Goldberger JJ. Atrial Myopathy Underlying Atrial Fibrillation. Arrhythm Electrophysiol Rev. 2020;9(2):61-70.
- Kamel H, Okin PM, Longstreth WT, Jr., Elkind MSV, Soliman EZ. Atrial cardiopathy: a broadened concept of left atrial thromboembolism beyond atrial fibrillation. Future cardiology. 2015;11(3):323-31.
- Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Cryptogenic Stroke. Circulation Research. 2017;120(3):527-40.
- Adams Jr HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. stroke. 1993;24(1):35-41.
- Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence‐based causative classification system for acute ischemic stroke. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 2005;58(5):688-97.
- Lamy C, Giannesini C, Zuber M, Arquizan C, Meder J, Trystram D, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Stroke. 2002;33(3):706-11.
- Packer M. Characterization, Pathogenesis, and Clinical Implications of Inflammation‐Related Atrial Myopathy as an Important Cause of Atrial Fibrillation. Journal of the American Heart Association. 2020;9(7):e015343.
- Johansen MC, Vasconcellos HDd, Nazarian S, Lima JAC, Gottesman RF. The Investigation of Left Atrial Structure and Stroke Etiology: The I‐LASER Study. Journal of the American Heart Association. 2021;10(2):e018766.
- Bhat A, Khanna S, Chen HH, Lee L, Gan GCH, Negishi K, et al. Impairment of left atrial function and cryptogenic stroke: Potential insights in the pathophysiology of stroke in the young. IJC Heart & Vasculature. 2020;26:100454.
- Gazagnes J, Gollion C, Fournier P, Cariou E, Larrue V, Lairez O. Left Atrial Function in Young Patients With Cryptogenic Stroke and Patent Foramen Ovale: A Left Atrial Longitudinal Strain Study. Frontiers in Neurology. 2020;11(1341).
- Leong DP, Joyce E, Debonnaire P, Katsanos S, Holman ER, Schalij MJ, et al. Left Atrial Dysfunction in the Pathogenesis of Cryptogenic Stroke: Novel Insights from Speckle-Tracking Echocardiography. J Am Soc Echocardiogr. 2017;30(1):71-9.e1.
- Gąsiorek P, Sakowicz A, Banach M, von Haehling S, Bielecka-Dabrowa A. Arterial Stiffness and Indices of Left Ventricular Diastolic Dysfunction in Patients with Embolic Stroke of Undetermined Etiology. Dis Markers. 2019;2019:9636197.
- Pirinen J, Järvinen V, Martinez‐Majander N, Sinisalo J, Pöyhönen P, Putaala J. Left Atrial Dynamics Is Altered in Young Adults With Cryptogenic Ischemic Stroke: A Case‐Control Study Utilizing Advanced Echocardiography. Journal of the American Heart Association. 2020;9(7):e014578.
- Meisel K, Yuan K, Fang Q, Bibby D, Lee R, Schiller NB. Embolic Stroke of Undetermined Source: A Population with Left Atrial Dysfunction. J Stroke Cerebrovasc Dis. 2019;28(7):1891-6.
- Tan C, OuYang M, Kong D, Zhou X. Association Between the Left Atrial and Left Atrial Appendages Systole Strain Rate in Patients with Atrial Fibrillation. Med Sci Monit. 2016;22:4974-7.
- Kim D, Shim CY, Hong GR, Kim MH, Seo J, Cho IJ, et al. Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients With Stroke. Stroke. 2016;47(6):1444-51.
- Habibi M, Zareian M, Ambale Venkatesh B, Samiei S, Imai M, Wu C, et al. Left Atrial Mechanical Function and Incident Ischemic Cerebrovascular Events Independent of AF: Insights From the MESA Study. JACC Cardiovasc Imaging. 2019;12(12):2417-27.
- Obokata M, Negishi K, Kurosawa K, Tateno R, Tange S, Arai M, et al. Left atrial strain provides incremental value for embolism risk stratification over CHA₂DS₂-VASc score and indicates prognostic impact in patients with atrial fibrillation. J Am Soc Echocardiogr. 2014;27(7):709-16.e4.
- Eshoo S, Ross DL, Thomas L. Impact of mild hypertension on left atrial size and function. Circ Cardiovasc Imaging. 2009;2(2):93-9.
- Xu TY, Sun JP, Lee AP, Yang XS, Ji L, Zhang Z, et al. Left atrial function as assessed by speckle-tracking echocardiography in hypertension. Medicine (Baltimore). 2015;94(6):e526.
- Saraiva RM, Demirkol S, Buakhamsri A, Greenberg N, Popović ZB, Thomas JD, et al. Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr. 2010;23(2):172-80.
- Kamel H, Soliman EZ, Heckbert SR, Kronmal RA, Longstreth Jr W, Nazarian S, et al. P-wave morphology and the risk of incident ischemic stroke in the Multi-Ethnic Study of Atherosclerosis. Stroke. 2014;45(9):2786-8.
- Barnes ME, Miyasaka Y, Seward JB, Gersh BJ, Rosales AG, Bailey KR, et al., editors. Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation. Mayo Clinic Proceedings; 2004: Elsevier.
- Di Tullio MR, Sacco RL, Sciacca RR, Homma S. Left atrial size and the risk of ischemic stroke in an ethnically mixed population. Stroke. 1999;30(10):2019-24.
- Benjamin EJ, D’Agostino RB, Belanger AJ, Wolf PA, Levy D. Left atrial size and the risk of stroke and death: the Framingham Heart Study. Circulation. 1995;92(4):835-41.
- Brecht A, Oertelt-Prigione S, Seeland U, Rücke M, Hättasch R, Wagelöhner T, et al. Left Atrial Function in Preclinical Diastolic Dysfunction: Two-Dimensional Speckle-Tracking Echocardiography-Derived Results from the BEFRI Trial. J Am Soc Echocardiogr. 2016;29(8):750-8.
- Tang B, Zhang H, Jiang L. The correlation between the mouth diameter of left atrial appendage and stroke risk score in patients with atrial fibrillation. Eur Rev Med Pharmacol Sci. 2015;19(5):790-4.