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.
Key Words
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Article info
Publication history
Published online: October 20, 2016
Accepted:
September 15,
2016
Received in revised form:
September 11,
2016
Received:
August 25,
2016
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.09.023
Copyright
© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
