Is left atrial diameter related to ischemic stroke?

Öz

Purpose: Stroke is the second leading cause of death and the third leading cause of disability worldwide. The highest recurrence rates are observed in subtypes such as large artery atherosclerosis (LAA) and cardioembolic (CE) stroke. Atrial fibrillation (AF) is a common cause of CE. However, the role of increased left atrial (LA) size as a potential risk factor for ischemic stroke remains controversial. This study aimed to evaluate whether LA size is associated with the long-term risk of stroke recurrence in patients with non-valvular atrial fibrillation.
Materials and methods: This retrospective study included 191 patients diagnosed with ischemic stroke by a specialist neurologist at Afyonkarahisar University of Health Sciences between January 1, 2024, and June 1, 2024. Patients aged >18 years with acute ischemic stroke were included. Patients with a history of ischemic stroke who had not undergone transthoracic echocardiography were excluded. The etiological subtype of ischemic stroke was determined according to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria.
Results: A total of 191 patients were included. Of these, 155 (81.2%) had non-recurrent stroke, while 36 (18.8%) experienced recurrent stroke. Smoking was significantly more common in patients with recurrent ischemic stroke (30.6% vs. 16.1%; p=0.046). The prevalence of AF was also higher in the recurrent stroke group (33.3% vs. 12.9%; p=0.003). Moreover, LA diameter was significantly greater in patients with recurrent ischemic stroke (median [interquartile range]: 43 [35.75-47] vs. 35 [33-37]; p<0.001).
Conclusion: This study demonstrates that increased LA diameter, smoking, and AF are associated with a higher risk of recurrent ischemic stroke. Notably, larger LA diameter may contribute to blood stasis and thrombus formation in the left atrium, thereby elevating the risk of CE events. Further research is warranted to confirm these associations and strengthen the current evidence base.

Anahtar Kelimeler

• Atrial fibrillation
• ischemic stroke
• LA diameter

Sol atrium çapı iskemik inme ile ilişkili midir?

Öz

Amaç: İnme, dünya çapında ikinci en sık ölüm nedeni ve üçüncü en sık sakatlık nedenidir. En yüksek nüks oranları büyük arter aterosklerozu ve kardiyoembolik inme gibi alt tiplerde görülmektedir. Atriyal fibrilasyon kardiyoembolik inmenin yaygın bir nedenidir. Ancak sol atriyum çapındaki artışın iskemik inme için potansiyel bir risk faktörü olup olmadığı tartışmalıdır. Bu çalışmanın amacı, sol atriyum çapının kapak hastalığına bağlı olmayan atriyal fibrilasyonu olan hastalarda uzun dönem inme tekrarı riski ile ilişkili olup olmadığını değerlendirmektir.
Gereç ve yöntem: Bu retrospektif çalışmaya, 1 Ocak 2024 ile 1 Haziran 2024 tarihleri arasında Afyonkarahisar Sağlık Bilimleri Üniversitesi’nde uzman nörolog tarafından iskemik inme tanısı konulan 191 hasta dahil edildi. Dahil edilme kriterleri 18 yaş üzeri olup akut iskemik inme tanısı alan hastalardı. Önceden inme öyküsü olan ancak transtorasik ekokardiyografi yapılmamış hastalar çalışma dışında bırakıldı. İskemik inmenin etiyolojik alt tipi TOAST (Trial of Org 10172 in Acute Stroke Treatment) kriterlerine göre belirlendi.
Bulgular: Çalışmaya toplam 191 hasta dahil edildi. Bunların 155’i (%81,2) tekrarlamayan inme grubunda, 36’sı (%18,8) ise tekrarlayan inme grubundaydı. Sigara kullanımı, tekrarlayan inme grubunda anlamlı olarak daha yüksekti (%30,6’ya karşı %16,1; p=0,046). Atriyal fibrilasyon sıklığı da tekrarlayan inme grubunda daha fazlaydı (%33,3’e karşı %12,9; p=0,003). Ayrıca, sol atriyum çapı tekrarlayan iskemik inme hastalarında anlamlı derecede daha büyüktü (ortanca [çeyrekler arası aralık]: 43 [35,75-47] mm’ye karşı 35 [33-37] mm; p<0,001).
Sonuç: Bu çalışma, sol atriyum çapındaki artışın, sigara kullanımının ve atriyal fibrilasyonun tekrarlayan iskemik inme riski ile ilişkili olduğunu göstermektedir. Özellikle sol atriyum çapındaki genişleme, atriyumda kan stazı ve trombüs oluşumuna katkıda bulunarak kardiyoembolik olay riskini artırabilir. Bu ilişkilerin doğrulanması ve mevcut kanıtların güçlendirilmesi için ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Atriyal fibrilasyon
• iskemik inme
• sol atriyum çapı

Kaynakça

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