The Role of Left Atrial Volume Index in Patients with a First-ever Acute Ischemic Stroke

Abstract

Background: Although an enlarged left atrium has recently emerged as a marker of adverse outcomes in various diseases, its discriminatory value and prognostic role in acute ischemic stroke (AIS) are not well studied. We studied whether left atrial volume index (LAVI) predicts mortality and discriminates stroke subtypes after AIS.

Methods: We prospectively followed 310 consecutive first-ever AIS patients aged 50 years or older who were admitted to the hospital within 24 hours of the onset of stroke symptoms. The type of AIS was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. All of the patients underwent transthoracic echocardiography within the first 24 hours. LAVI was measured with the biplane area-length method and categorized as 28 mL/m² or lower (normal), 28.1-32 mL/m², 32.1-36 mL/m², and >36 mL/m². The patients were followed for 1 year or until death, whichever came first.

Results: The LAVI of the cardioembolic group was significantly higher than that of the noncardioembolic group (32.4 ± 4.0 versus 29.7 ± 3.4 mL/m², respectively; P < .001). The optimal cutoff value, sensitivity, and specificity of LAVI to distinguish cardioembolic stroke from noncardioembolic stroke were 30 mL/m², 81%, and 64%, respectively. Mortality in each LAVI category was 4%, 7.8%, 25.9%, and 70.9%, respectively (P = .026). Kaplan-Meier analysis showed that there was a stepwise increase in risk of mortality with each increment of LAVI category.

Conclusions: The LAVI can distinguish cardioembolic stroke from noncardioembolic stroke and provides an independent information over clinical and other echocardiographic variables for predicting mortality in patients with first-ever AIS.

Keywords: Left atrium; acute ischemic stroke; echocardiography; prognosis.