Left atrial myocardial strain, assessed by the method of speckle-tracking echocardiography, as a marker of fibrosis in patients with ischemic stroke

Introduction. Cardioembolic stroke (CE) is one of the main etiopathogenetic subtypes of ischemic stroke and accounts for approximately 17% of all patients with ischemic stroke. Currently, there is a search for widely accessible radiological diagnostic methods that allow for the accurate diagnosis of left atrial (LA) dysfunction. Among these methods is transthoracic strain echocardiography (EchoCG), which provides additional information about the degree of deformation and change in shape of the LA during the cardiac cycle. To date, the association between strain EchoCG parameters and the severity of fibrotic changes in the LA among patients with CE remains unstudied.

Objective. To evaluate the relationship between myocardial deformation parameters of the left atrium and the degree of fibrosis in patients with CE, as well as the impact of LA myocardial deformation changes on the prognosis of patients with CE.

Materials and Methods. A prospective cross-sectional study included 132 patients who underwent evaluation and treatment in the Department of Emergency Neurology at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2020 to 2022. Group 1 consisted of 12 patients who died during hospitalization, while Group 2 comprised 120 patients who were discharged from the department after receiving treatment.

Results. Deceased patients, compared to survivors, were characterized by the presence of LA myocardial remodeling. Statistically significant differences in LA myocardial deformation parameters were found between the study groups. Correlation analysis revealed statistically significant associations between LA myocardial deformation parameters and the severity of fibrotic changes. In the multifactorial logistic regression model, significant effects on the prognosis of patients were observed for LA strain peak systolic circumferential strain rate (LA-Scs) and LA strain peak systolic longitudinal strain rate (LA-Sls), with each 1% increase in the parameter associated with a 1.128-fold and 1.075-fold increase in the odds of a lethal outcome, respectively (OR: 1.128, 95% CI: 1.021–1.25, p = 0.017, and OR: 1.075, 95% CI: 1.009–1.15, p = 0.025).

Conclusions. The conducted study established a strong correlation between LA myocardial deformation and LA fibrosis and the degree of fibrosis in the LA. LA myocardial deformation parameters can be used in risk stratification for the development of a lethal outcome in patients with CE. 

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