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A new interesting article has been published in J Stroke Cerebrovasc Dis. 2019 Jul;28(7):1891-1896. doi: 10.1016/j.jstrokecerebrovasdis.2019.04.004. Epub 2019 Apr 26. and titled:

Embolic Stroke of Undetermined Source: A Population with Left Atrial Dysfunction.

Authors of this article are:

Meisel K, Yuan K, Fang Q, Bibby D, Lee R, Schiller NB.

A summary of the article is shown below:

BACKGROUND: Cryptogenic stroke, now defined as embolic stroke of undetermined source (ESUS), represents about a quarter of all ischemic strokes and the reoccurrence is high. Understanding this stroke subtype better would likely guide treatment recommendations. In this study, we tested the hypothesis that left atrial (LA) shape and function at rest, as well as with exercise, are abnormal compared to matched normal controls.METHODS: The study design was prospective enrollment of ESUS subjects who underwent measurement of LA function at rest and exercise by 2D and 3D echocardiograms. The exercise portion of the study was conducted using a ramped supine bicycle protocol during which LA function was measured. Stroke subjects were matched with normal subjects by age, gender, and body surface area.RESULTS: Over a 1-year enrollment period, 18 ESUS patients met inclusionary criteria and were studied. Their average age was 58 years old and 44% were female. ESUS subjects have larger LA end-diastolic volume at rest (14 versus 11 mL/m2, P = .04) and with exercise (11 versus 6 mL/m2, P = .001) compared to normal controls. In ESUS, there was a lack of response to maximal exercise of LA function as measured by the LA ejection fraction (61% versus 73% P = .001) and the LA function index (.68 versus .82, P = .02). The 3D analysis showed spherical remodeling of the LA in ESUS. This remodeling was documented by the sphericity index, which was increased in both diastole (.40 versus .32, P = .02) and systole (.63 versus .71 P = .03).CONCLUSIONS: In support of our hypothesis, we found that ESUS subjects have LA dysfunction and remodeling at rest and exercise in comparison to healthy, matched controls. Evaluation of the left atrium in this high-risk stroke subtype has potential to inform stroke prevention strategies and to suggest pathways for research.Copyright © 2019 Elsevier Inc. All rights reserved.

Check out the article’s website on Pubmed for more information:

[link-preview url=https://www.ncbi.nlm.nih.gov/pubmed/31031144 forceshot=true]

This article is a good source of information and a good way to become familiar with topics such as: Aged;Case-Control Studies;Echocardiography, Stress;Echocardiography, Three-Dimensional;Exercise Test;Female;Heart Atria;Heart Diseases;Humans;Intracranial Embolism;Male;Middle Aged;Predictive Value of Tests;Prognosis;Prospective Studies;Risk Assessment;Risk Factors;Stroke.

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