title: Left atrial deformation parameters predict left atrial appendage function and thrombus in patients in sinus rhythm with suspected cardioembolic stroke: a speckle tracking and transesophageal echocardiography study.
abstract: The aim of this study was to evaluate left atrial deformations using speckle tracking echocardiography for predicting left atrial appendage (LAA) thrombus in patients with suspected cardioembolic stroke who were in normal sinus rhythm. A total of 153 ischemic stroke patients (89 males, 64 females) in sinus rhythm who were suspected of having cardioembolism were included in the study. The patients underwent conventional two-dimensional (2D) echocardiogram and 2D speckle tracking echocardiogram of the left atrium. Left atrial peak strain (LA-4C-RES) and left atrial precontraction strain (LA-4C-PUMP) were measured. Patients were divided into 2 groups according to the presence of thrombus in the LAA in transesophageal echocardiography. Both LA-4C-RES and LA-4C-PUMP values were found to be significantly lower in patients with LAA thrombus (11.8 ± 1.4% vs. 33 ± 12%, P < 0.001 and 5.8 ± 1.3% vs. 14.2 ± 5.3%, P < 0.001, respectively). A good inverse correlation was present between LA-4C-RES values and LAA morphologic parameters (with LAA area: r = -0.70, P < 0.001, with LAA length: r = -0.60, P < 0.001), and a good positive correlation was present with LAA emptying velocity with pulse Doppler (r = 0.74, P < 0.001). The area under the receiver-operating characteristic curve of the LA-4C-RES was 0.94 (0.90-0.98, P < 0.001), for the LA-4C-PUMP, the area was 0.92 (0.87-0.96, P < 0.001) to predict LAA thrombus. Left atrial deformation parameters measured by 2D speckle tracking method was found to predict impaired LAA functions and the presence of LAA thrombus in ischemic stroke patients with suspected cardioembolism, but who are in sinus rhythm.
authors.affiliation: Cardiology Clinic, Kartal Koşuyolu Heart & Research Hospital, Istanbul, Turkey. karabaymd@yahoo.com
authors.forename: Can Yücel
authors.initials: CY
authors.lastname: Karabay
authors.forename: Regayip
authors.initials: R
authors.lastname: Zehir
authors.forename: Ahmet
authors.initials: A
authors.lastname: Güler
authors.forename: Vecih
authors.initials: V
authors.lastname: Oduncu
authors.forename: Arzu
authors.initials: A
authors.lastname: Kalayci
authors.forename: Soe Moe
authors.initials: SM
authors.lastname: Aung
authors.forename: Ali
authors.initials: A
authors.lastname: Karagoz
authors.forename: Ibrahim Halil
authors.initials: IH
authors.lastname: Tanboga
authors.forename: Ozkan
authors.initials: O
authors.lastname: Candan
authors.forename: Cetin
authors.initials: C
authors.lastname: Gecmen
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.forename: Ali Metin
authors.initials: AM
authors.lastname: Esen
authors.forename: Cevat
authors.initials: C
authors.lastname: Kirma
mesh_terms: D000328:Adult; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016279:Atrial Function, Left / Q000502:physiology; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology