Abstract
BackgroundLeft atrial appendage (LAA) volume has been shown to be increased in patients with acute cryptogenic stroke. Atrial fibrillation (AF) is a well-recognized risk factor but it is not the only one associated with LAA enlargement. The aim of the study was to clarify the multifactorial etiology of LAA enlargement in cardiogenic stroke/TIA patients without AF.MethodsAltogether 149 patients with suspected cardioembolic stroke/TIA (47 females; mean age 61 years) underwent cardiac CT. Diagnosed AF on admittance was an exclusion criteria but 24-hour Holter ambulatory ECG revealed paroxysmal AF (PAF) in 20 patients. Body surface area adjusted LAA volume was evaluated. Eighteen different variables were registered including general characteristics, definite and potential causal risk factors for ischemic stroke/TIA, clinical echoparameters and CT based cardiac volumetric and adipose tissue measurements. A stepwise linear regression analysis was performed to achieve a model adjusted for the number of predictors of LAA volume increase.ResultsIn linear regression analysis, the best model accounted for 30% of the variability in LAA volume, including PAF (19%) and enlarged left atrial volume (6%), enlarged left ventricle end-systolic diameter (3%) and decreased pericardial adipose tissue (2%). No multi-colinearity between variables was observed. In addition to PAF, no other definitive or potential causal risk factors could account for the LAA volume in these patients.ConclusionsLAA volume increase seems to be poorly associated with currently known stroke/TIA risk factors, except for AF. Targeting more comprehensive ECG monitoring for stroke patients with increased LAA volume should be considered.
Highlights
Despite improvements in stroke mortality in Western societies, stroke remains the second leading cause of death worldwide [1]
The Left atrial appendage (LAA) has been shown to be frequently enlarged in patients with acute cryptogenic stroke or a transient ischemia attack (TIA) [5]
body surface area (BSA)-adjusted values were used in regression analyses
Summary
Despite improvements in stroke mortality in Western societies, stroke remains the second leading cause of death worldwide [1]. The LAA has been shown to be frequently enlarged in patients with acute cryptogenic stroke or a transient ischemia attack (TIA) [5]. Both AF and PAF are known to contribute to LAA enlargement [9,10]. The factors associated with LAA volume increase are not fully understood. Left atrial appendage (LAA) volume has been shown to be increased in patients with acute cryptogenic stroke. Atrial fibrillation (AF) is a well-recognized risk factor but it is not the only one associated with LAA enlargement. The aim of the study was to clarify the multifactorial etiology of LAA enlargement in cardiogenic stroke/TIA patients without AF
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