Atrial dyssynchrony and left atrial stiffness are risk markers for cryptogenic stroke in patients with patent foramen ovale.

Abstract

The clinical and echocardiographic parameters associated with the risk predictors of cryptogenic stroke (CS) in patients with patent foramen ovale (PFO) still diverse and with a great debate. We hypothesized that left atrial stiffness (LASt) and atrial dyssynchrony may increase the risk of CS in patients with PFO. A total of 129 consecutive patients presented without clinical reasoning of stroke were recruited. Transesophageal echocardiographic assessment was performed to investigate the presence of PFO. PFO was identified in 52% (group I) and absent in 48% (group II). Utilizing speckle-tracking imaging LASt and atrial dyssynchrony was evaluated among patients with PFO (group I) vs those without PFO (group II). LASt was significantly increased in group I patients compared with group II (P<.001). Likewise patients with PFO had a significant LA dyssynchrony compared with those in group II (P<.001). Interatrial dyssynchrony and left atrial dyssynchrony were correlated with LASt (r=.47 and 0.51, respectively; P<.001). Cardiac arrhythmias were significantly encountered in group I patients (at presentation and with Holter monitoring) P<.001. Besides significantly increase in atrial dyssynchrony and in LASt in patients with arrhythmias compared with those without (P<.001). ROC analysis revealed that LASt index≥0.61 and LA dyssynchrony≥23.5 predicts cardiac arrhythmias in CS patients with PFO with (AUC: 0.85 and 0.87, respectively, P<.001). In conclusion, we demonstrated that LASt and atrial dyssynchrony might be risk markers of cryptogenic stroke in patients with PFO.