The role of left atrial myocardial deformation assessment in the comprehensive diagnosis of cardioembolic stroke

Introduction. One of the new methods for assessing atrial cardiomyopathy is speckle tracking echocardiography, which allows for non-invasive diagnosis of left atrial (LA) dysfunction.

Purpose. Determination the diagnostic role of LA myocardial deformation in the development of cardioembolic stroke (CS).

Materials and methods. The study included 150 patients in the acute period of ischemic stroke (IS). The patients were divided into 2 groups: group I consisted of 30 patients with EI, group II — 120 people with other etiopathogenetic types of IS. All patients underwent transthoracic echocardiography with assessment of myocardial deformation of the left chambers of the heart.

Results. The values of LA diameter, volume and indexed volume in group I were greater and amounted to 39 [36.3; 41] mm, 65.5 [55.8; 77.5] ml and 37 [25.8; 44.8] ml/m2, respectively. Indicators of myocardial deformation of the LA in patients of group I went beyond normal values and differed statistically significantly, amounting to 14.1 [5.25; 22]%, −10 [−11.5; −5.25]% and −4.25 [−10.4; 0.575]% for the deformation indicators in the reservoir phase (LP-SrKD), conductor (LPSprKD) and contraction (LPSkKD), respectively. When conducting multivariate regression analysis adjusted for confounders, LPSprKD and LPScrKD remained statistically significant indicators. Thus, each subsequent increase in the LPScrCD indicator by 1% increased the chances of CEI by 1.151 times (OR: 1.151, 95% CI: 1.043–1.271, p = 0.006), each subsequent increase in the LPScrCD indicator by 1% — by 1.11 times (OR : 1.102, 95% CI: 1.032–1.178, p = 0.004). ROC analysis was performed to determine the optimal diagnostic threshold and diagnostic performance of strain analysis in relation to CS.

Conclusions. In group I, statistically significantly higher values of LA sizes and volumes were recorded, and LA deformation indicators were statistically significantly different from the indicators of group II and were outside the normal range. It was established that statistically significant indicators of LA myocardial deformation, allowing for the diagnosis of CEI, were LPSprCD and LPScrCD. 

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