Impaired transport function of the left atrium and left atrial appendage in cryptogenic stroke patients with atrial septal aneurysm and without patent foramen ovale.
OBJECTIVE
Although atrial septal aneurysm (ASA) is frequently combined with patent foramen ovale and associated with cryptogenic stroke (CS), a pathophysiologic correlation between CS and ASA alone has not been fully elucidated. The aims of this study were to assess transport functions of the left atrium (LA) and left atrial appendage (LAA), and to evaluate their relationship in CS subjects with ASA alone.


RESULTS
This study consisted of 38 CS subjects with ASA alone and 38 matched controls. Transthoracic echocardiography including tissue Doppler imaging was performed in all subjects and transesophageal echocardiography was conducted in CS subjects to assess LAA emptying velocity (LAAev). We also measured soluble P- and E-selectin, interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) as indices of prothrombogenic and proinflammatory activity. Although there were no differences in left ventricular functions and baseline characteristics between the two groups, CS subjects had significantly larger LA volume and lower LA active pump function compared with controls. LAAev was significantly correlated with LA active function. CS subjects had significantly higher E-selectin (P = 0.046), IL-6 (P = 0.040), and hs-CRP (P = 0.001) compared with controls.


CONCLUSIONS
Compared with controls, LA active pump function was significantly depressed and closely correlated with LAAev in CS subjects with ASA alone. Moreover, plasma levels of E-selectin, IL-6, and hs-CRP were significantly higher in CS subjects with ASA alone. These findings suggest that impaired LA and LAA functions are a crucial pathophysiologic mechanism for ischaemic stroke in subjects with ASA alone.
Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Jin Oh
JO
Na
Seung Yong
SY
Shin
Hong Euy
HE
Lim
Cheol Ung
CU
Choi
Seong Hwan
SH
Kim
Jin Won
JW
Kim
Eung Ju
EJ
Kim
Eun Mi
EM
Lee
Seung-Woon
SW
Rha
Chang Gyu
CG
Park
Hong Seog
HS
Seo
Dong Joo
DJ
Oh
Young-Hoon
YH
Kim
D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000473:pathology*; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D019040:E-Selectin / Q000097:blood; D004452:Echocardiography; D005260:Female; D054092:Foramen Ovale, Patent; D006322:Heart Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology*; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology*; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D013223:Statistics as Topic; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology*
D015415:Biomarkers; D019040:E-Selectin; D015850:Interleukin-6; D019007:P-Selectin; D002097:C-Reactive Protein