Abstract

Cardioembolic stroke is a serious disease with poor prognosis, whose main embolic source is the left atrial appendage (LAA). Left atrial (LA) strain evaluated by the two-dimensional (2D) speckle tracking technique has been proposed. However, the commonly used peak LA strain reflects only LA reservoir function. The LA strain also includes indicators of the other LA functions, such as booster pump function, which reflects active contraction of the LA. This study aimed to investigate whether a newly developed parameter, the left atrial strain time integral (LASTI), can evaluate LAA dysfunction more accurately in patients with acute stroke. We measured LA strain using a 2D speckle tracking method in 168 patients with acute stroke and 20 age-matched control subjects. LASTI was calculated as the area under the LA strain curve in one cardiac cycle. LAA dysfunction was defined as LAA thrombus and/or severe spontaneous echo contrast by transesophageal echocardiography. LASTI was significantly lower in patients with LAA dysfunction than those without. LASTI was a better correlation with LAA blood flow velocity measured by transesophageal echocardiography than peak LA strain. Multivariate logistic regression analysis showed that LASTI was an independent predictor of LAA dysfunction after adjustment for conventional risk factors. LASTI can be a feasible parameter for predicting LAA dysfunction in patients with acute stroke.

中文翻译：

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二维散斑追踪评估的左心房应变时间积分可预测急性缺血性卒中患者的左心耳功能障碍

摘要

心源性脑卒中是一种预后不良的严重疾病，其主要栓塞源是左心耳（LAA）。已经提出通过二维（2D）散斑跟踪技术评估左心房（LA）应变。然而，常用的峰值 LA 应变仅反映 LA 储库功能。 LA 应变还包括其他 LA 功能的指标，例如反映 LA 主动收缩的增压泵功能。本研究旨在探讨新开发的参数左心房应变时间积分 (LASTI) 是否可以更准确地评估急性卒中患者的左心耳功能障碍。我们使用 2D 散斑追踪方法测量了 168 名急性中风患者和 20 名年龄匹配的对照受试者的 LA 应变。 LASTI 计算为一个心动周期内 LA 应变曲线下的面积。 LAA 功能障碍被定义为 LAA 血栓和/或经食管超声心动图显示的严重自发回声对比。左心耳功能障碍患者的 LASTI 显着低于无左心耳功能障碍的患者。与峰值 LA 应变相比，LASTI 与经食管超声心动图测量的 LAA 血流速度具有更好的相关性。多变量逻辑回归分析表明，在调整常规危险因素后，LASTI 是左心耳功能障碍的独立预测因子。 LASTI 可以作为预测急性卒中患者左心耳功能障碍的可行参数。