Left atrial and ventricular longitudinal strain in embolic stroke of undetermined source

Öz

Purpose: Left atrial (LA) and left ventricular (LV) remodelling may lead to stroke. The aim of this study was to
analyze LA function and LV strain in patients with embolic stroke of undetermined source (ESUS).
Material and methods: This prospective study included 35 ESUS patients and 37 age and sex-matched
controls. All participants underwent brain computed tomography (CT), conventional and diffusion-weighted
magnetic resonance imaging (MRI), CT or MR angiography, 12 lead ECG, transthoracic echocardiography, and
48 hour Holter ECG monitoring. LA volume and function were determined by echocardiography. LA reservoir and
LV strains were measured longitudinally by speckle-tracking method. CHA2DS2-VASc, The National Institutes
of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) scores were calculated.
Results: Major cardiovascular risk factors were similar between the two groups. The mean CHA2DS2-VASc
score was 2.6±1.2. NIHSS was 3.9±3.0 and mRS was 1.3±0.8. Atrial electromechanical coupling intervals and
delays, LA emptying fraction and volumes were similar between the two groups. LA reservoir strain was lower than
controls (25.2±7.2% vs. 29.7±8.8%, p=0,019). LV global longitudinal strain was lower than controls (-14.7±4.2%
vs -16.4±3.9%, p=0,031). There was no correlation between LA, LV strains and the scores (CHA2DS2-VASc,
NIHSS, mRS).
Conclusions: ESUS patients had lower LA reservoir and LV longitudinal global strains than controls. Left atrial
volume index, LA emptying fraction did not differ between the two groups. Echocardiographic quantification of
LA and LV remodelling has great potential for secondary prevention from ESUS. Further studies are needed to
confirm our findings.

Anahtar Kelimeler

• Embolic stroke
• left atrial function
• left ventricular function
• left atrial strain
• left ventricular strain

Kaynağı belirlenemeyen embolik inmede sol atriyal ve ventriküler longitudinal strain

Öz

Amaç: Sol atriyal ve sol ventriküler yeniden şekillenme inmeye neden olabilir. Bu çalışmanın amacı, kaynağı
belirsiz embolik inme (ESUS) hastalarında sol atriyum fonksiyonlarını ve sol ventrikül strain değerlerini analiz
etmektir.
Gereç ve yöntem: Bu prospektif çalışma cinsiyet ve yaş açısından benzer olan 35 adet ESUS’lu hasta (61±10
yaşında) ve 37 adet kontrol grubunu (60±10 yaşında) içeriyordu. Tüm hastalara beyin bilgisayarlı tomografisi (BT),
konvansiyonel ve difüzyon manyetik rezonans görüntüleme (MRG), BT veya MR anjiyografi, 12 derivasyonlu
EKG, transtorasik ekokardiyografi ve 48 saat Holter EKG monitörizasyonu yapıldı. Sol atriyum hacimleri ve
fonksiyonları ekokardiyografi ile belirlendi. Sol atriyum rezervuar ve ventrikül strain değerleri speckle-tracking
metoduyla longitudinal olarak ölçüldü. CHA2DS2-VASc, Amerikan Ulusal Sağlık Enstitüsü İnme Skalası
(NIHSS), Modifiye Rankin Skalası (mRS) skorları hesaplandı.
Bulgular: Major kardiyovasküler risk faktörleri iki grup arasında da benzerdi. ESUS’lu hastaların ortalama
CHA2DS2-VASc skoru 2,6±1,2, NIHSS 3,9±3,0 ve mRS 1,3±0,8 saptandı. Atrial elektromekanik süreler ve
gecikme zamanları, sol atriyum boşalma fraksiyonu ve hacim indeksleri 2 grup arasında benzer bulundu. Sol
atriyal rezervuar strain, kontrol grubuna göre düşük saptandı (25,2±%7,2 vs. 29,7±%8,8, p=0.019). Sol ventrikül
global longitudinal strain kontrol grubuna göre düşük saptandı (-14,7±%4,2 vs -16,4±%3,9, p=0.031). Sol
atriyum rezervuar ve sol ventrikül strain değerleri ile skorlar arasında korelasyon saptanmadı (CHA2DS2-VASc,
NIHSS, mRS).
Sonuç: ESUS’lu hastalar, kontrol grubuna göre daha düşük sol atriyal rezervuar ve sol ventriküler global
longitudinal straine sahipti. Sol atriyal hacim indeksleri, sol atriyum boşalma fraksiyonu ve elektromekanik süreler
2 grup arasında farklılık göstermemektedir. Sol atriyal ve ventriküler yeniden şekillenmesinin ekokardiyografik
ölçümü, ESUS’tan ikincil koruma için büyük bir potansiyele sahiptir. Bulgularımızın doğrulanması için daha fazla
çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

• Embolik inme
• sol atriyal fonksiyon
• sol ventriküler fonksiyon
• sol atriyal strain
• sol ventriküler strain

Kaynakça

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