Document Type : Review Article


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


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.


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