Left atrial shape as a marker of atrial myopathy in embolic stroke of undetermined source

Aaisha Ferkh; Kasun De Silva; Jennifer Pham; Luke Stefani; Karen Byth; Amy Clark; Siddharth J Trivedi; Sai Nagaratnam; Andrew Duggins; Eddy Kizana; Aravinda Thiagalingam; Liza Thomas

doi:10.1093/ehjci/jeae078

Left atrial shape as a marker of atrial myopathy in embolic stroke of undetermined source

Eur Heart J Cardiovasc Imaging. 2024 Mar 15:jeae078. doi: 10.1093/ehjci/jeae078. Online ahead of print.

Authors

Aaisha Ferkh^{1

2}, Kasun De Silva^{1

2}, Jennifer Pham², Luke Stefani^{1

2}, Karen Byth³, Amy Clark^{1

2}, Siddharth J Trivedi^{1

2}, Sai Nagaratnam⁴, Andrew Duggins^{1

4}, Eddy Kizana^{1

2

5}, Aravinda Thiagalingam^{1

2}, Liza Thomas^{1

2

6}

Affiliations

¹ Westmead Clinical School, University of Sydney, Westmead NSW, Australia.
² Cardiology Department, Westmead Hospital, Westmead NSW, Australia.
³ WSLHD Research and Education Network, Westmead Hospital NSW, Australia.
⁴ Neurology Department, Westmead Hospital, Westmead NSW, Australia.
⁵ Centre for Heart Research, The Westmead Institute for Medical Research.
⁶ South-West Clinical School, University of New South Wales, Liverpool NSW, Australia.

PMID: 38487870
DOI: 10.1093/ehjci/jeae078

Abstract

Aims: Embolic Stroke of Undetermined Source (ESUS) results in significant morbidity. A left atrial (LA) myopathy is implicated in a proportion of these patients. We hypothesized that LA shape varies by cause of stroke (cardioembolic versus ESUS).

Methods and results: 236 ischemic stroke, atrial fibrillation (AF) patients and controls were recruited prospectively. AF was classified as paroxysmal (PAF) or persistent AF (PersAF). Stroke patients comprised cardioembolic stroke (CE) secondary to AF and ESUS. There were 81 AF (47 PAF, 34 PersAF), 50 ESUS, 57 CE patients (subdivided into CE with PAF (CEpaf) and CE with PersAF (CEpers) and 48 controls. Echocardiographic parameters including LA volume, function, and shape/sphericity (3D LA-sphericity and 2D-derived LA-circularity, ellipticity, sphericity and eccentricity indices) were evaluated. Increased LA volume and sphericity with LA dysfunction was present in CE, AF and ESUS groups compared to controls. K-means cluster analysis demonstrated a spectrum of LA myopathy with controls at the lowest and CEpers and PersAF at the upper extremes, with ESUS, PAF and CEpaf being similar and falling between these extremes. After adjusting for age, sex and left ventricular (LV) and LA parameters, LA sphericity markers differentiated ESUS from controls (p < 0.01).

Conclusions: Alterations in LA shape are present in ESUS, AF and CE patients, particularly increased spherical remodelling. The novel markers of LA sphericity proposed may identify LA myopathy in ESUS patients and potentially guide management for secondary prevention.

Keywords: echocardiography; left atrial function; left atrial myopathy; left atrial shape; left atrial sphericity; left atrial strain; left atrium.

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