Introduction
Methods and materials
Study population
Standard echocardiography
Speckle-tracking echocardiography
Statistical analysis
Results
Patient characteristics
Overall (N = 208) | Stroke/TIA (N = 31) | Control (N = 177) | P value | |
---|---|---|---|---|
Clinical characteristics | ||||
Gender,male | 133 (63.9) | 20 (64.5) | 113 (63.8) | 0.94 |
Age,years | 63.58 ± 10.37 | 68.32 ± 7.57 | 62.75 ± 10.59 | < 0.01 |
Body mass index,kg/m2 | 24.37 ± 3.20 | 24.72 ± 3.07 | 24.31 ± 3.22 | 0.52 |
Heart failure | 33 (15.9) | 10 (32.3) | 23 (13.0) | < 0.01 |
Coronary artery disease | 37 (17.8) | 7 (22.6) | 30 (16.9) | 0.45 |
Hypertension | 111 (53.4) | 19 (61.3) | 92 (52.0) | 0.34 |
Diabetes | 45 (21.6) | 8 (25.8) | 37 (20.9) | 0.54 |
Hyperlipoproteinemia | 58 (27.9) | 5 (16.1) | 53 (29.9) | 0.11 |
Persistent AF | 120 (57.7) | 20 (64.5) | 100 (56.5) | 0.40 |
Anticoagulation | 145 (69.7) | 23 (74.2) | 122 (68.9) | 0.56 |
CHA2DS2-VASc score before stroke | 1.82 ± 1.26 | 2.29 ± 1.16 | 1.73 ± 1.26 | 0.02 |
Conventional echocardiographic parameters | ||||
iLVESV,mL/m2 | 24.18 ± 9.40 | 27.82 ± 14.40 | 23.56 ± 8.17 | 0.13 |
iLVEDV,mL/m2 | 66.84 ± 14.55 | 70.56 ± 17.95 | 66.21 ± 13.85 | 0.13 |
LVEF,% | 64.26 ± 8.24 | 61.58 ± 8.73 | 64.72 ± 8.09 | 0.05 |
iLAAPd,mm/ m2 | 22.77 ± 3.82 | 23.48 ± 3.72 | 22.64 ± 3.83 | 0.26 |
iLAVmin,mL/m2 | 27.88 ± 15.48 | 34.86 ± 18.81 | 26.63 ± 14.53 | < 0.01 |
iLAVmax,,mL/m2 | 41.67 ± 17.08 | 47.79 ± 22.96 | 40.57 ± 15.63 | 0.03 |
LAEF, % | 35.2 ± 16.00 | 28.56 ± 13.69 | 36.39 ± 16.13 | 0.01 |
LAAEV,m/s | 0.53 ± 0.24 | 0.45 ± 0.25 | 0.54 ± 0.23 | 0.09 |
LAAFV,m/s | 0.53 ± 0.20 | 0.47 ± 0.23 | 0.54 ± 0.20 | 0.10 |
LAA dense SEC/thrombus | 36 (18.5) | 11 (40.7) | 25 (14.9) | < 0.01 |
ilAAVmin,mL/m2 | 1.89 ± 1.58 | 2.06 ± 1.53 | 1.86 ± 1.59 | 0.53 |
iLAAVmax,mL/m2 | 4.24 ± 2.41 | 4.12 ± 2.58 | 4.26 ± 2.38 | 0.77 |
LAAEF,% | 57.30 ± 19.83 | 51.86 ± 16.81 | 58.19 ± 20.19 | 0.13 |
Strain echocardiographic parameters | ||||
LA GLS,% | 18.08 ± 9.64 | 13.09 ± 7.01 | 19.99 ± 9.79 | < 0.01 |
LA MD,% | 8.91 ± 3.76 | 11.56 ± 4.38 | 8.43 ± 3.44 | < 0.01 |
LAA GLS,% | 12.15 ± 5.82 | 9.01 ± 3.12 | 12.66 ± 6.00 | < 0.01 |
LAA MD,% | 11.53 ± 4.78 | 15.15 ± 5.46 | 10.94 ± 4.40 | < 0.01 |
Factors associated with prior stroke/TIA
Variables | Univariate analysis | Multivariate analysis | ||||||
---|---|---|---|---|---|---|---|---|
OR (95% CI) | P value | Model 1 | Model 2 | Model 3 | ||||
OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | |||
Clinical parameters | ||||||||
Age | 1.07 (1.02–1.12) | < 0.01 | 1.06 (1.01–1.13) | 0.03 | 1.07 (1.01–1.14) | 0.03 | 1.08 (1.01–1.40) | 0.02 |
Female | 1.03 (0.46–2.29) | 0.94 | 2.17 (0.79–6.02) | 0.14 | 2.44 (0.85–7.03) | 0.09 | ||
Heart failure | 3.19 (1.33–7.62) | 0.01 | 1.85 (0.63–5.45) | 0.27 | 1.56 (0.48–5.24) | 0.46 | ||
CHA2DS2-VASc score | 1.41 (1.04–1.19) | 0.03 | 1.04 (0.55–1.97) | 0.91 | 1.14 (0.57–2.29) | 0.71 | 1.07 (0.57–1.63) | 0.71 |
LA parameters | ||||||||
LAEF | 0.97 (0.94–0.99) | 0.01 | 1.00 (0.96–1.04) | 0.99 | ||||
iLAVmax | 1.02 (1.00–1.04) | 0.03 | 0.99 (0.96–1.02) | 0.53 | 0.99 (0.96–1.03) | 0.81 | ||
LA GLS | 0.91 (0.86–0.97) | < 0.01 | 0.99 (0.90–1.09) | 0.88 | 0.99 (0.89–1.10) | 0.77 | 0.99 (0.89–1.09) | 0.78 |
LA MD | 1.25 (1.22–1.39) | < 0.01 | 1.20 (1.07–1.36) | < 0.01 | 1.29 (1.11–1.49) | < 0.01 | 1.18 (1.03–1.34) | < 0.01 |
LAA parameters | ||||||||
LAAEV | 0.18 (0.02–1.33) | 0.09 | 16.81 (1.28–220.9) | 0.03 | 4.83 (0.45–52.15) | 0.05 | ||
LAAEF | 0.98 (0.97–1.00) | 0.13 | 1.01 (0.98–1.05) | 0.45 | ||||
LAA dense SEC/thrombus | 3.93 (1.64–9.46) | < 0.01 | 4.39 (1.33–14.53) | 0.02 | 3.63 (1.16–11.35) | 0.03 | ||
LAA GLS | 0.84 (0.75–0.94) | < 0.01 | 0.96 (0.85–1.09) | 0.53 | 0.96 (0.84–1.10) | 0.57 | 0.96 (0.84–1.09) | 0.49 |
LAA MD | 1.21 (1.09–1.32) | < 0.01 | 1.19 (1.07–1.33) | < 0.01 | 1.22 (1.08–1.38) | < 0.01 | 1.21 (1.08–1.36) | < 0.01 |
Incremental value of LA MD and LAA MD in risk stratification of stroke
The priorities of LA and LAA MD for risk stratification of stroke in patients with and without LA enlargement
Norma LA volumes | Univariable | Multivariable | ||||||||||||
N = 81, stroke = 10 | OR (95% CI) | P | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | Model 6 | ||||||
OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | |||
CHA2DS2-VASc score | 1.26 (0.73–2.18) | 0.40 | ||||||||||||
LA GLS (%) | 0.88 (0.79–0.97) | 0.01 | 0.97 (0.86–1.08) | 0.56 | 0.88 (0.79–0.97) | 0.01 | 0.86 (0.77–0.97) | < 0.01 | 0.87 (0.77–0.97) | < 0.01 | 0.88 (0.79–0.99) | 0.04 | ||
LA MD (%) | 1.51 (1.16–1.97) | < 0.01 | 1.51 (1.16–1.97) | < 0.01 | 1.51 (1.16–1.97) | < 0.01 | 1.85 (1.23–2.79) | < 0.01 | 1.55 (1.15–2.09) | < 0.01 | 1.66 (1.13–2.42) | < 0.01 | ||
LAEF(%) | 0.94 (0.89–0.98) | 0.01 | 0.97 (0.91–1.03) | 0.28 | 0.97 (0.92–1.04) | 0.40 | 0.94 (0.89–0.99) | 0.02 | 0.95 (0.90–1.01) | 0.11 | 0.95 (0.90–1.01) | 0.09 | ||
LAAEV (cm/s) | 1.96 (0.01–4.36) | 0.70 | 0.87 (0.33–22.89) | 0.21 | 1.00 (0.05–19.73) | 0.89 | 1.97 (0.07–55.22) | 0.24 | 1.00 (0.05–20.46) | 0.98 | 0.47 (0.02–9.61) | 0.63 | ||
LAA GLS(%) | 0.80 (0.65–0.99) | 0.05 | 0.90 (0.72–1.13) | 0.36 | 0.92 (0.75–1.12) | 0.39 | 0.80 (0.65–1.00) | 0.05 | 0.80 (0.65–0.99) | 0.05 | 0.85 (0.68–1.06) | 0.15 | ||
LAA MD (%) | 1.31 (1.06–1.61) | 0.01 | 1.26 (0.99–1.61) | 0.06 | 1.33 (0.99–1.77) | 0.06 | 1.28 (1.02–1.60) | 0.03 | 1.31 (1.06–1.61) | 0.01 | 1.27 (1.01–1.59) | 0.04 | ||
Abnormal LA volumes | Univariable | Multivariable | ||||||||||||
N = 127, stroke = 21 | OR (95% CI) | P | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | Model 6 | ||||||
OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | |||
CHA2DS2-VASc score | 1.47 (1.00–2.14) | 0.05 | ||||||||||||
LA GLS (%) | 0.93 (0.84–1.02) | 0.10 | 0.99 (0.92–1.08) | 0.33 | 0.93 (0.84–1.02) | 0.10 | 0.89 (0.81–1.00) | 0.05 | 0.93 (0.83–1.05) | 0.26 | 0.90 (0.81–1.01) | 0.07 | ||
LA MD (%) | 1.18 (1.02–1.35) | 0.03 | 1.18 (1.02–1.35) | 0.03 | 1.18 (1.02–1.35) | 0.01 | 1.21 (1.04–1.41) | 0.01 | 1.17 (0.99–1.36) | 0.05 | 1.16 (0.99–1.35) | 0.06 | ||
LAEF (%) | 0.99 (0.96–1.02) | 0.41 | 1.01 (0.97–1.05) | 0.90 | 0.98 (0.95–1.01) | 0.54 | 0.99 (0.95–1.03) | 0.56 | 0.99 (0.95–1.03) | 0.65 | 0.99 (0.95–1.02) | 0.42 | ||
LAAEV (cm/s) | 0.02 (0.00–0.76) | 0.04 | 0.15 (0.01–4.29) | 0.34 | 0.10 (0.01–2.71) | 0.16 | 0.03 (0.01–0.94) | 0.05 | 0.06 (0.01–2.52) | 0.14 | 0.05 (0.01–2.22) | 0.12 | ||
LAA GLS (%) | 0.85 (0.73–0.98) | 0.02 | 0.84 (0.72–0.98) | 0.02 | 0.91 (0.79–1.06) | 0.06 | 0.84 (0.72–0.97) | 0.02 | 0.85 (0.73–0.98) | 0.02 | 0.91 (0.78–1.06) | 0.22 | ||
LAA MD (%) | 1.17 (1.05–1.31) | < 0.01 | 1.16 (1.04–1.30) | < 0.01 | 1.15 (1.03–1.29) | 0.01 | 1.17 (1.05–1.30) | < 0.01 | 1.16 (1.04–1.30) | < 0.01 | 1.17 (1.05–1.31) | < 0.01 |