{"paper_id":"0f4b93ef-0099-4e91-a74f-7942c31b8841","body_text":"RT-3DE TEE combined with STI to evaluate the correlation between left atrial and left auricular function and stroke in patients with non-valvular atrial fibrillation: a clinical investigation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article RT-3DE TEE combined with STI to evaluate the correlation between left atrial and left auricular function and stroke in patients with non-valvular atrial fibrillation: a clinical investigation Xinyi Li, Shiyi Huang, Chang Zhou, Xingyu Liu, Runyu Zhu, Wenshu Hu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7888856/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Apr, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 13 You are reading this latest preprint version Abstract Aim : Non-valvular atrial fibrillation (NVAF) serves as the primary cause of cardiogenic embolic stroke (CES), and the recurrence rate and mortality of CES are on an annual upward trend. The objective is to explore the structural and functional changes of the left atrial (LA) and left atrial appendage (LAA) in patients with NVAF by means of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in combination with two-dimensional speckle tracking imaging (2D-STI), and to identify the risk factors for CES. Methods : A total of 125 patients with NVAF were recruited from our hospital, among whom 55 had CES and 70 did not. Additionally, 96 controls with sinus rhythm were included. General clinical data, as well as transthoracic and transesophageal echocardiographic data, were collected. RT-3D TEE and 2D-STI were employed to assess the structural and functional characteristics of the LA and LAA. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to evaluate the independent risk factors and their predictive value for CES. Result : In comparison with the control group, both NVAF groups exhibited elevated LA and LAA volumes as well as impaired functional parameters, with more pronounced alterations observed in the CES subgroup. Multivariate logistic regression analysis determined that CHA₂DS₂-VASc≥2, impaired LA reservoir strain (LASr), and an increased LAA maximum volume index (LAAVImax) were independent risk factors for CES. ROC curve analysis indicated that LAAVImax (AUC= 0.803) and LASr (AUC=0.720) had greater predictive value than CHA₂DS₂-VASc≥2 alone (AUC=0.685). The combination of all three factors resulted in the highest predictive accuracy (AUC=0.854). Conclusion : Patients with NVAF and CES demonstrate more significant dysfunction of the LA and LAA. The LASr and LAAVImax are robust predictors of CES and enhance risk stratification when integrated with clinical scores. Clinical trial numbe r: Not applicable. Echocardiography transesophageal Atrial fibrillation Stroke Left atrial Left atrial appendage Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Stroke is an acute cerebrovascular disorder resulting from the sudden rupture or occlusion of cerebral blood vessels, causing impaired brain tissue perfusion and subsequent neuronal damage or necrosis [ 1 ] .Recent statistical data indicate that stroke has emerged as the second leading cause of death and the third leading cause of disability globally [ 2 ] . Ischemic stroke constitutes over 80% of all stroke cases [ 3 ] . Moreover, ischemic stroke resulting from cerebral artery embolism caused by dislodged emboli of cardiac origin, namely, cardiogenic embolic stroke (CES), constitutes approximately 20–30% of ischemic strokes. It is more severe, exhibits a higher recurrence rate, and has a poorer prognosis [ 4 – 7 ] . Atrial fibrillation (AF) stands as the most significant risk factor for CES, and clinical investigations have demonstrated that strokes associated with AF constitute over 79% of all CES cases [ 8 ] . Non-valvular atrial fibrillation (NVAF), as the principal subtype, results in a five-fold elevation in the risk of ischemic stroke when compared to individuals in sinus rhythm [ 9 , 10 ] . The CHA 2 DS 2 -VASc scoring system has been extensively employed to stratify the stroke risk in patients with AF and to direct the anticoagulation therapy [ 11 – 13 ] . Nevertheless, a greater number of studies have demonstrated that the structural and functional parameters of the left atrial (LA) and left atrial appendage (LAA) can effectively forecast the occurrence of AF-related stroke and might be superior to the CHA 2 DS 2 -VASc scoring system [ 14 – 16 ] . The CHA 2 DS 2 -VASc scoring system solely depends on the patient's clinical parameters and does not integrate the functional imaging parameters of the LA and LAA, which are closely associated with the occurrence of stroke. Consequently, the accuracy of stroke risk assessment for patients with clinically abnormal cardiac function and low scores requires improvement. In patients with AF, the LA and LAA undergo pathological alterations as a result of hemodynamic disturbances and abnormal functional remodeling, which in turn lead to cardiomyocyte damage and a hypercoagulable state of the blood.Owing to the distinctive, narrow, and curved structure of the LAA, research findings have indicated that approximately 90% of thrombi in strokes associated with AF originate from the LAA [ 17 ] .Furthermore, structural and functional abnormalities of the LA also increase the risk of thrombosis. Numerous studies have demonstrated that the structure and function of both the LA and LAA can be investigated as potential risk factors for stroke in patients with AF [ 18 , 19 ] . Two-dimensional speckle tracking imaging (2D-STI) offers a non-invasive method to monitor myocardial speckle motion, thereby indicating early functional alterations in the LA and LAA. This technique enables the acquisition of key parameters, including atrial strain and strain rate. Real-time three-dimensional echocardiography (RT-3DE) enables visualization and dynamic presentation of the three-dimensional structure of the atria, and acquires parameters associated with atrial volume and function [ 20 ] . Despite the distinct benefits offered by each technique, there is a notable scarcity of studies that have integrated RT-3DE with 2D-STI for a thorough and comprehensive evaluation.This integrated assessment approach is anticipated to offer a more thorough predictor for evaluating stroke risk in patients with AF, thereby enhancing the predictive accuracy of the CHA 2 DS 2 -VASc scoring system. This study aimed to utilize RT-3DE in conjunction with 2D-STI to analyze the structural and functional alterations in the LA and LAA among NVAF patients with concurrent CES. Additionally, it sought to investigate the mechanisms and risk factors underlying the onset of CES in NVAF patients. The ultimate goal was to enhance early risk stratification, complement the CHA 2 DS 2 -VASc scoring system, and provide guidance for personalized treatment strategies to improve patient outcomes. Methods Study population From September 2022 to October 2024, 125 NVAF patients without LAA thrombus were enrolled from the Department of Cardiology at our hospital, and their LA and LAA ultrasound images were collected. The mean follow-up duration for all patients was 9.1 months, with the primary endpoint being the occurrence of CES. Based on the presence or absence of CES during the follow-up period, patients were categorized into the NVAF group (n=70, no CES) and the NVAF+CES group (n=55, with CES). Additionally, 96 patients in sinus rhythm during the same period were selected as a control group. This study received approval from the Medical Ethics Committee of our hospital (Approval number: 2024-183-01), and all participants provided signed informed consent. Inclusion and exclusion criteria Patients fulfilled the diagnostic criteria for NVAF according to the 2024 European Society of Cardiology (ESC) Guidelines on the Management of Atrial Fibrillation [21] , and those with CES adhered to the Chinese Expert Consensus on the Diagnosis of Cardiogenic Stroke (2020) [22] . All participants provided signed informed consent. Excluded from the study were patients with congenital heart disease, cardiomyopathy, organic mitral valve disease, or severe heart failure; those with pulmonary embolism, deep venous thrombosis, or other conditions leading to stroke; individuals with carotid artery plaque stenosis of 75% or more, or vulnerable carotid plaques as confirmed by ultrasound; patients with severe hepatic or renal insufficiency, or malignant tumors; those with incomplete clinical or imaging data; and subjects experiencing atrial fibrillation during the ultrasound examination or whose image quality was insufficient for analysis by post-processing software. Instrumentation A Philips EPIQ CVx color Doppler ultrasound diagnostic machine, featuring an X5-1 three-dimensional matrix probe operating at 1-5 MHz, was employed in this study. It was equipped with a real-time three-dimensional full volume imaging system and a QLAB 13.0 post-processing workstation. Routine echocardiographic parameter acquisition Subjects were positioned in the left lateral decubitus, instructed to breathe calmly, and two-dimensional echocardiography was conducted following simultaneous connection to the ECG. The left atrial anteroposterior diameter (LAD) was measured in the parasternal long-axis view. The left ventricular end-diastolic diameter (LVEDD) was assessed in the same view using M-mode ultrasound. The left ventricular ejection fraction (LVEF) was determined via the biplane Simpson's method. Pulsed Doppler measurements were obtained in the apical 4-chamber view to quantify the early peak flow rate of mitral valve filling (E) during early diastole. The pulsed Doppler sampling volume was positioned at the mitral annulus, both on the septal side and the lateral wall side of the left ventricle, to capture the mean peak early diastolic mitral annular velocity (e'), with the E/e' ratio subsequently calculated. Four consecutive cardiac cycle images were recorded and stored, and the aforementioned parameters were averaged by repeating the measurements three times. 2D-STI parameter acquisition The apical four-chamber heart image displayed on the left atrial wall was selected and imported into the QLAB 13.0 post-processing workstation. The AutoStrain LA mode was then chosen to manually adjust the left atrial endocardium, identifying three key points on both sides of the mitral valve and at the atrial apex to ensure the endocardial envelope was fully delineated. The software subsequently computed the left atrial reservoir strain (LASr), left atrial duct strain (LAScd), and left atrial auxiliary pump strain (LASct), as illustrated in Fig.1-1. These parameters were measured three times to obtain an average value. RT-3DE parameter acquisition The apical 4-chamber heart section was selected, and the real-time 3D volumetric imaging system was activated once the endocardium of the left atrium was clearly visualized. Continuous acquisition of dynamic images from at least 4 cardiac cycles was performed, which were subsequently imported into the QLAB 13.0 post-processing workstation. The 3DQ Advance mode was selected, and the sampling point was positioned on the endocardial surface of the left atrium. The morphology of the left atrium was adjusted to generate the time-volume curve. From this curve, the left atrial maximum volume (LAVmax), left atrial presystolic volume (LAVpre), and left atrial minimum volume (LAVmin) were derived, as illustrated in Fig.1-2. Following body surface area (BSA) standardization, the left atrial maximum volume index (LAVImax), left atrial presystolic volume index (LAVIpre), and left atrial minimum volume index (LAVImin) were obtained. Additionally, the left atrial ejection fraction (LVEF), left atrial expansion index (LAEI), left atrial passive ejection fraction (pasEF), and left atrial active ejection fraction (actEF) were calculated. The mean values of these parameters were determined by averaging three repeated measurements. Transesophageal echocardiographic parameter acquisition A Philips EPIQ CVx color Doppler ultrasound machine equipped with an X8-2t three-dimensional matrix probe operating at 2-7 MHz was utilized. The patient underwent transesophageal echocardiography under preoperative anesthesia while positioned in the left lateral decubitus position. Two-dimensional dynamic images of more than four cardiac cycles, clearly depicting the left auricle, were stored at a 90° view. Simultaneously, three-dimensional dynamic images of the LAA were acquired using the 3D-ZOOM imaging mode, with the images captured over four cycles.The left atrial appendage diameter (LAAD) and left atrial appendage height (LAAH) were measured at 0°, 45°, 90°, and 135°, respectively, and the average values were computed. The left atrial appendage emptying velocity (LAA-EV) and left atrial appendage filling velocity (LAA-FV) were assessed using spectral Doppler at a 90° section of the left atrium. The 2D dynamic images of the left atrium were imported into the QLAB 13.0 post-processing workstation to determine the left atrial appendage strain (LAAS), as illustrated in Fig.1-3.For the 3D full-volume dynamic image of the left auricle, the 3DQ Advance mode was employed to calculate the left atrial appendage maximum volume (LAAVmax), left atrial appendage minimum volume (LAAVmin), and left atrial appendage ejection fraction (LAAEF), as shown in Fig.1-4. These volumes were normalized to body surface area to derive the left atrial appendage maximum volume index (LAAVImax) and left atrial appendage minimum volume index (LAAVImin).Three-dimensional LA image analysis was conducted using the GI-3DQ plug-in, and the left atrial appendage maximal orifice area (LAA-OAmax) was measured at end-diastole following adjustment of the red, green, and blue planes, as depicted in Fig.1-5. All parameters were measured three times, and the mean values were recorded. Clinical data acquisition Medical records were reviewed to obtain the following data for each subject: sex, age, height, weight, creatinine levels, triglyceride levels, D-dimer levels, LDL cholesterol levels, history of hypertension, history of diabetes mellitus, history of previous stroke, body mass index (BMI), body surface area (BSA), and CHA 2 DS 2 -VASc score. Statistical analysis SPSS 27.0 and GraphPad Prism 9.4.1 statistical software were employed for data analysis. Measurements adhering to a normal distribution were presented as x̄±s. One-way analysis of variance (ANOVA) was utilized to compare means across multiple groups, with the LSD method applied for pairwise comparisons between groups. Data not conforming to normal distribution were expressed as M (P25, P75), and group comparisons were conducted using the non-parametric rank sum test. Count data were represented as cases and rates, with inter-group comparisons performed via the chi-square test or Fisher's exact probability method. Independent risk factors for CES in NVAF patients were identified through univariate and multivariate logistic regression analyses. The Receiver Operating Characteristic (ROC) curve was generated to assess the predictive efficacy of each factor for CES occurrence in NVAF patients, and the area under the curve (AUC) was computed. And P <0.05 denoted statistical significance. Results Consistent evaluation of structural and functional parameters of the LA and LAA Table 1 illustrates the application of RT-3D and 2D-STI for the quantitative analysis of intra- and inter-observer agreement evaluations concerning the structural-functional parameters of the LA and LAA, specifically LASr, LAScd, LASct, LAVImax, LAVIpre, LAVImin, LAAS, LAAVImax, LAAVImin, and LAA-OA. The findings demonstrated a high degree of intra- and inter-observer reproducibility for these parameters. Table 1: Consistent evaluation of structural and functional parameters of the LA and LAA Parameter ICC 95%CI P ICC 95%CI P LASr 0.91 0.418-0.96 ＜0.001 0.81 0.73-0.96 ＜0.001 LAScd 0.93 0.74-0.98 ＜0.001 0.87 0.57-0.96 ＜0.001 LASct 0.87 0.47-0.96 ＜0.001 0.91 0.68-0.95 ＜0.001 LAVImax 0.86 0.53-0.96 ＜0.001 0.89 0.60-0.97 ＜0.001 LAVIpre 0.93 0.74-0.98 ＜0.001 0.87 0.42-0.97 ＜0.001 LAVImin 0.92 0.67-0.98 ＜0.001 0.86 0.42-0.97 ＜0.001 LAAS 0.80 0.41-0.95 ＜0.001 0.85 0.52-0.96 ＜0.001 LAAVImax 0.81 0.43-0.95 ＜0.001 0.92 0.72-0.98 ＜0.001 LAAVImin 0.89 0.63-0.97 ＜0.001 0.94 0.77-0.98 ＜0.001 LAA-OAmax 0.91 0.67-0.97 ＜0.001 0.89 0.61-0.97 ＜0.001 LASr, left atrial reservoir strain; LAScd, left atrial duct strain; LASct, left atrial auxiliary strain; LAVImax, left atrial maximum volume index; LAVIpre, left atrial presystolic volume index; LAVImin, left atrial minimum volume index; LAAS, left atrial appendage strain; LAAVImax, left atrial appendage maximum volume index; LAAVImin, left atrial appendage minimum volume index; LAA-OAmax, left atrial appendage maximal orifice area; P <0.05 indicates statistical significance. Comparison of general clinical information There were no statistically significant differences among the three groups regarding gender, age, BMI, BSA, TG, Cr, D-dimer, LDL, systolic pressure, and diastolic pressure ( P >0.05). However, compared with the control group, the NVAF+CES group exhibited higher CK-MB levels and a greater proportion of individuals with a CHA 2 DS 2 -VASc≥2, which were statistically significant ( P <0.05). Additionally, when compared to the NVAF group, the NVAF+CES group had a larger proportion of individuals with a CHA 2 DS 2 -VASc≥2, and this difference was also statistically significant ( P <0.05). See Table 2. Table 2 Comparison of general clinical data parameters Parameter Control group （ n=96 ） NVAF （ n=70 ） NVAF+CES （ n=55 ） F/ c 2 P Man/Female 46/50 37/33 27/28 0.409 0.815 Age (years) 54.56±12.61 55.76±8.55 56.00±7.65 0.439 0.645 BMI（kg/m 2 ） 23.60±2.85 24.45±2.76 23.82±2.84 1.922 0.149 BSA（m 2 ） 1.72±0.15 1.70±0.13 1.69±0.17 0.368 0.693 CK-MB（ng/ml） 0.74±0.19 0.76±0.15 0.81±0.23 a 3.410 0.036 TG（mmol/L） 1.18±0.35 1.17±0.61 1.10±0.27 0.574 0.564 Cr（umol/L） 73.05±4.28 73.80±12.21 74.09±9.01 0.294 0.745 D-dimer（mg/L） 0.29±0.26 0.34±0.31 0.41±0.38 1.537 0.058 LDL（mmol/L） 2.12±0.61 2.19±0.53 2.24±0.47 0.764 0.106 Systolic pressure（mmHg） 118.36±4.54 119.54±18.89 119.49±3.25 0.291 0.747 Diastolic pressure （mmHg） 75.72±6.16 76.80±15.98 77.95±4.72 0.860 0.425 CHA 2 DS 2 -VASc 8.460 0.015 <2（n/％） 64（66.7） 45（64.2） 24（42.9） ≥2（n/％） 32（33.3） 25（35.7） 31（44.3） ab BMI, body mass index; BSA, body surface area; CK-MB, creatine kinase isoenzyme; TG, triglycerides; Cr, creatinine; LDL, low-density lipoprotein; CHA 2 DS 2 -VASc, atrial fibrillation embolism risk score. Statistical significance was defined as P <0.05, with differences marked as follows: a P <0.05 (vs. control group) and b P <0.05 (vs. NVAF group). Comparison of conventional electrocardiogram parameters The inter-group comparison revealed that, compared to the control group, both the NVAF and NVAF+CES groups exhibited elevated levels of LAD, LVEDD, E, and E/e', along with reduced LVEF, with these differences being statistically significant ( P <0.05). Additionally, when compared to the NVAF group, the NVAF+CES group demonstrated a further increase in LAD, also with statistically significant differences ( P <0.05). See Table 3. Table 3 Comparison of conventional echocardiographic parameters Parameter Control group （n=96） NVAF （n=70） NVAF+CES （n=55） F P LAD（mm） 35.47±3.16 40.54±6.34 a 44.40±6.21 ab 55.223 ＜0.001 LVEDD（mm） 44.15±3.69 46.57±4.42 a 47.20±3.59 a 13.352 ＜0.001 E（m/s） 0.70±0.015 0.77±0.22 a 0.79±0.016 a 9.468 0.027 E/e’ 9.51±0.81 10.73±3.59 a 12.34±4.37 a 15.486 ＜0.001 LVEF（％） 64.13±3.10 62.17±5.48 a 60.29±6.02 a 11.670 ＜0.001 LAD, left atrium anteroposterior diameter; LVEDD, left ventricular end-diastolic diameter; E, early peak velocity of blood flow during diastolic filling of the left ventricle; E/e', ratio of early peak velocity of mitral inflow (E) to early diastolic peak velocity of mitral annular tissue (e'); LVEF, left ventricular ejection fraction; LASr, left atrial reservoir strain; LAScd, left atrial duct strain. P <0.05 indicates statistically significant differences, marked as follows: a P <0.05 (vs. control group) and b P <0.05 (vs. NVAF group). Comparison of structural and functional parameters of the LA Compared to the control group, both the NVAF and NVAF+CES groups exhibited elevated LAVImax, LAVIpre, and LAVImin values ( P <0.05), whereas LASr, LAScd, LASst, LAEI, LAEF, and pasEF levels significantly decreased ( P <0.05). Furthermore, the NVAF+CES group showed a statistically significant reduction in actEF relative to the control group ( P <0.05). When contrasted with the NVAF group, the NVAF+CES group demonstrated higher LAVImax, LAVIpre, and LAVImin values ( P <0.05) and lower LASr, LAScd, LASst, and LAEI levels, all with statistically significant differences ( P <0.05). See Table 4 and Fig.2-1. Table 4 Comparison of structural and functional parameters of the LA Parameter Control group （ n=96 ） NVAF （ n=70 ） NVAF+CES （ n=55 ） F P LASr（％） 30.02±3.50 22.59±7.68 a 17.53±3.16 ab 110.534 ＜0.001 LAScd（％） 17.36±2.55 13.94±2.80 a 12.23±2.33 ab 47.399 ＜0.001 LASct（％） 12.79±1.86 10.16±2.09 a 9.25±1.56 ab 24.806 ＜0.001 LAVImax（ml/m 2 ） 27.57±4.07 33.41±7.64 a 36.97±5.90 ab 49.252 ＜0.001 LAVIpre（ml/m 2 ） 21.67±3.52 28.54±6.84 a 32.29±5.24 ab 80.876 ＜0.001 LAVImin（ml/m 2 ） 17.66±3.34 24.31±6.22 a 28.66±5.07 ab 51.137 ＜0.001 LAEI 0.57±0.12 0.40±0.09 a 0.30±0.07 ab 44.908 0.039 LAEF（％） 36.55±5.13 27.46±5.12 a 26.62±3.92 a 103.349 ＜0.001 pasEF（％） 28.43±4.27 24.68±4.52 a 23.66±3.18 a 29.213 ＜0.001 actEF（％） 19.82±5.53 19.08±5.90 17.39±3.96 a 3.682 0.027 LASr, left atrial reservoir strain; LAScd, left atrial duct strain; LASct, left atrial auxiliary pump strain; LAVImax, left atrial maximum volume index; LAVIpre, left atrial presystolic volume index; LAVImin, left atrial minimum volume index; LAEI, left atrial expansion index; LAEF, left atrial ejection fraction; pasEF, left atrial passive ejection fraction; actEF, left atrial passive ejection fraction.The positive/negative sign of strain values denotes direction, not magnitude. For comparative ease, all strain values in this study are presented as absolute values. Statistical significance ( P <0.05) is indicated as follows: a P <0.05 (vs. control group) and b P < 0.05 (vs. NVAF group). Comparison of structural and functional parameters of the LAA Compared to the control group, both the NVAF and NVAF+CES groups exhibited increased LAAD, LAAH, LAA-OAmax, LAAVImax, and LAAVImin ( P <0.05). Conversely, LAA-EV, LAA-FV, LAAS, and LAAEF showed significant decreases ( P <0.05). In the NVAF+CES group, LAAD, LAA-OAmax, LAAVImax, and LAAVImin were all higher than those in the NVAF group ( P <0.05), whereas LAAS decreased, with all these differences being statistically significant ( P <0.05). See Table 5 and Fig.2-2. Table 5 Comparison of structural and functional parameters of the LAA Parameter Control group （ n=96 ） NVAF （ n=70 ） NVAF+CES （ n=55 ） F P LAAD（cm） 1.82±0.37 2.26±0.47 a 2.56±0.41 ab 60.470 ＜0.001 LAAH（cm） 2.70±0.35 3.12±0.54 a 3.31±0.46 a 39.379 ＜0.001 LAA-EV（cm/s） 47.74±3.71 40.67±10.80 a 38.85±5.98 a 33.489 ＜0.001 LAA-FV（cm/s） 49.18±5.73 39.38±9.01 a 39.67±4.69 a 55.982 ＜0.001 LAAS（％） 8.50±1.10 7.03±1.75 a 6.03±1.09 ab 63.853 ＜0.001 LAAVImax（ml/m 2 ） 3.40±0.54 4.66±1.13 a 5.74±0.57 ab 162.946 ＜0.001 LAAVImin（ml/m 2 ） 1.93±0.48 3.18±0.67 a 3.99±0.92 ab 178.910 ＜0.001 LAAEF（％） 40.17±4.81 31.26±9.69 a 30.86±7.26 a 42.442 ＜0.001 LAA-OAmax（cm 2 ） 3.79±0.54 5.08±2.12 a 6.01±0.99 ab 50.581 ＜0.001 LAAD, left atrial appendage diameter; LAAH, left atrial appendage height; LAA-EV, left atrial appendage emptying velocity; LAAFV, left atrial appendage filling velocity; LAAS, left atrial appendage strain; LAAVImax, left atrial appendage maximum volume index; LAAVImin, left atrial appendage minimum volume index; LAAEF, left atrial appendage ejection fraction; LAA-OAmax, left atrial appendage maximum office area. The positive/negative sign of strain values denotes direction, not magnitude. For comparative purposes, all strain values in this study are presented as absolute values. Statistical significance ( P <0.05) is indicated as follows: a P <0.05 (vs. control group) and b P <0.05 (vs. NVAF group). Analysis of risk factors for CES in NAVF patients One-way factor analysis revealed that CHA 2 DS 2 -VASc≥2, LASr, LAScd, LASst, LAVImax, LAVImin, LAVIpre, LAAS, LAAVImax, and LAA-OA were significantly associated with NVAF-induced cardioembolic stroke ( P <0.05). Multivariate logistic regression analysis further identified CHA 2 DS 2 -VASc≥2, LASr, and LAAVImax as independent risk factors for CES in NVAF patients. See Table 6. Table 6 Analysis of single and multiple factors for CES in NVAF patients Parameter One factor analysis Multiple factor Logistic analysis OR（95% CI） P OR（95% CI） P CHA 2 DS 2 -VASc≥2 1.208（0.097～0.449） ＜0.001 1.163（1.051～1.517） 0.002 LASr（％） 0.866（0.805～0.931） ＜0.01 0.853（0.760～0.957） 0.015 LAScd（％） 0.776（0.669～0.900） ＜0.01 LASct（％） 0.768（0.627～0.940） 0.011 LAVImax（ml/m²） 1.077（1.021～1.137） 0.007 LAVIpre（ml/m²） 1.104（1.037～1.174） 0.002 LAVImin（ml/m²） 1.143（1.065～1.226） ＜0.001 LAEI 0.803（0.735～1.078） 0.264 LAAD（cm） 1.239（1.150～1.342） 0.069 LAAS（％） 0.721（0.654～0.869） ＜0.01 LAAVImax 3.788（2.218～6.434） ＜0.01 2.520（1.198～5.298） 0.015 LAAVImin（ml/m 2 ） 3.704（2.123～6.464） 0.149 LAA-OAmax（cm 2 ） 1.389（1.100～1.753） 0.006 LASr, left atrial reservoir strain; LAScd, left atrial duct strain; LASct: Left atrial auxiliary pump strain; LAVImax, left atrial maximum volume index; LAVIpre, left atrial presystolic volume index; LAVImin, left atrial minimum volume index; LAEI, left atrial expansion index; LAAD, left atrial appendage diameter; LAAS, left atrial appendage strain; LAAVImax, left atrial appendage maximum volume index; LAAVImin, left atrial appendage minimum volume index; LAAEF, left atrial appendage ejection fraction; LAA-OAmax, left atrial appendage maximum orifice area. P <0.05 indicates a statistically significant difference. ROC curve analysis ROC curve analysis revealed that the area under the curve (AUC) for predicting CES in AF patients was 0.685, 0.720, and 0.803 for CHA 2 DS 2 -VASc≥2, LASr, and LAAVImax, respectively. The corresponding cutoff values were 22.62% for CHA 2 DS 2 -VASc≥2, and 4.98 ml/m² for LASr and LAAVImax, with sensitivities of 72.7%, 91.2%, and 90.9%, and specificities of 64.3%, 47.1%, and 62.9%, respectively. The combined predictor of LASr and LAAVImax yielded an AUC of 0.809, with a sensitivity of 92.7% and specificity of 62.9%. In contrast, the combined predictor of CHA 2 DS 2 -VASc≥2, LASr, and LAAVImax demonstrated an AUC of 0.854, sensitivity of 90.9%, and specificity of 68.6%. See Table 7 and Fig.2-3. Table 7 ROC Analysis of Risk Factors Risk factor AUC 95 ％ CI P Optimal cut-off value Sensitivity (%) Specificity (%) CHA 2 DS 2 -VASc 0.685 0.590～0.780 ＜0.001 / 72.7 64.3 LASr 0.720 0.629～0.811 ＜0.001 22.62 91.2 47.1 LAAVImax 0.803 0.726～0.881 ＜0.001 4.98 90.9 62.9 LAAVImax+ LASr 0.809 0.732～0.886 ＜0.001 / 92.7 62.9 Combined indicators* 0.854 0.788～0.919 ＜0.001 / 90.9 68.6 Combined indicator* : CHA 2 DS 2 -VASc, LAAVImax, LASr combined Discussion The LAA, an embryonic remnant of the primitive LA, possesses distinct anatomical and functional attributes. It exhibits autonomous systolic and diastolic functions, serves as a \"pressure regulator\" for the LA, adapts to volumetric changes, and secretes natriuretic peptides [ 25 ] . The diminished effective contraction of the LA and LAA in patients with AF, coupled with their narrow tubular anatomy, predisposes the LAA to hypercoagulation and blood stasis, thereby increasing the risk of thrombosis. Consequently, the LAA serves as the primary source of CES [ 23 , 24 ] . The morphology of the LAA and its clinical significance remain subjects of ongoing debate. The shape of the LAA is typically categorized into distinct forms such as chicken wing, windward band, cactus, and cauliflower [ 26 ] .In patients with AF, the LA and LAA experience a loss of effective contraction. Additionally, the narrow, tubular anatomy of the LAA predisposes it to hypercoagulation and blood stasis, thereby increasing the risk of thrombosis. Qi Shuyuan et al [ 27 ] found that non-chicken-wing LAA morphology was an independent risk factor for thromboembolic risk in AF patients with CHA 2 DS 2 -VASc ≤ 1. However, Xinyan Wang et al [ 17 ] found that LAA morphology was not a risk factor for stroke in patients with NVAF, which was similar to the findings of Wu et al [ 28 ] , suggesting that there was no significant correlation between LAA morphology and stroke risk in patients with NVAF. This discrepancy can be attributed to the subjective nature of LAA morphological classification and the limited predictive value of anatomical data. Consequently, a comprehensive assessment necessitates the integration of both institutional and functional parameters of the LAA. 2D-STI is executed by tracking the speckle motion of myocardial tissue, thereby obtaining myocardial motion velocities, strain rates, and strain parameters [ 29 , 30 ] . RT-3DE can directly visualize the three-dimensional anatomical structure of the LA and LAA, and perform precise quantitative analysis of their functional status, which holds significant clinical value. Transesophageal real-time 3D echocardiography (RT-3D TEE) imaging boasts high resolution and enables the observation of three-dimensional anatomical images of the LAA from various angles. Based on this, the study employed RT-3D TEE in conjunction with 2D-STI to examine the structure and function of the LA and LAA in NVAF patients. Additionally, it aimed to investigate the risk factors and underlying mechanisms of CES in NVAF patients, thereby providing a crucial reference for the prevention and treatment of CES. The results of this study revealed that LASr, LAScd, and LASct were significantly lower, whereas LAVImax, LAVIpre, and LAVImin were markedly higher in the NVAF and NVAF + CES groups compared to the control group, with all differences achieving statistical significance ( P < 0.05). Conversely, the NVAF + CES group exhibited reduced LA strain and elevated volume index relative to the NVAF group. These findings suggest that AF adversely impacts LA function, resulting in diminished strain and increased volume across all periods, with these changes being particularly pronounced in patients within the stroke group. Cardiomyocytes in patients with AF undergo atrial remodeling in response to stressor stimulation [ 31 ] , leading to increased LA myocardial fibrosis, enlarged volume, diminished compliance, and weakened contraction, aligning with the findings of this study. Shao Li et al [ 32 ] showed that LA structure-function remodeling in AF patients was also indicated. In general, LA regulates left ventricular (LV) filling through storage, conduit, and co-pumping phases to promote LV blood circulation. Blood from the systemic venous return is stored in the ventricle during systole. During early and mid-diastole, blood passively flows from the LA into the LV, which facilitates LV filling during late diastole through the contraction of LA. The study's findings revealed that the NVAF and NVAF + CES groups exhibited higher values for LAAD, LAAH, LAA-OAmax, LAAVImax, and LAAVImin compared to the control group. Conversely, LAA-EV, LAA-FV, LAAS, and LAAEF were lower in these groups than in the control group. All these differences were statistically significant ( P < 0.05). In the NVAFA + CES group, LAAD, LAA-OAmax, LAAVImax, and LAAVImin increased, and LAAS decreased, and the differences were statistically significant ( P < 0.05). It was observed that in patients with NVAF, the LAA volume expanded, the opening area enlarged, whereas the strain and ejection fraction diminished, and the LAA emptying and filling velocities reduced.The underlying cause of this phenomenon may be attributed to left heart remodeling induced by AF. During AF episodes, this remodeling impacts the LA and LAA cardiomyocytes, prompting fibrosis and altering myocardial compliance and stiffness. Consequently, this results in an enlarged LAA volume and diminished strain [ 33 , 34 ] . The LAA boasts superior compliance and enhanced blood storage capacity, attributed to its crucial function and unique anatomical structure [ 35 ] . In prolonged LV dysfunction, the compliance of the LAA diminishes, resulting in heightened dilatation and increased stiffness. This progression ultimately leads to structural and functional remodeling of both the LA and LAA. CES represents a significant hazard, with its incidence steadily increasing [ 36 ] , and AF emerges as its primary risk factor. This study delves into the mechanism of stroke in patients with NVAF. We conducted a comparative analysis of the structure and function of the LA and LAA between the NVAF group and the NVAF + CES group. Our findings indicate that the LA and LAA in patients with CES exhibit significantly reduced strain, increased volume, and diminished function. The mechanism underlying NVAF-induced CES is intricate. Research has demonstrated that blood flow stasis, endothelial damage, and structural remodeling due to AF collectively facilitate thrombosis. Notably, in 90% of AF patients, the thrombus is localized within the LAA [ 37 ] . However, a study by Buckley et al [ 38 ] found no difference in stroke risk between patients who received rhythm control therapy and those who did not. This implies that an inherent pro-thrombotic atrial matrix abnormality might precede the onset of AF. Atrial cardiomyopathy can be precipitated by factors such as age and diabetes, resulting in thrombosis even in the absence of arrhythmia. This condition interacts with AF, thereby heightening the risk of stroke [ 39 , 41 ] . Many patients with cryptogenic stroke develop AF long after the initial event, a phenomenon potentially linked to post-stroke neurohumoral imbalances and inflammatory responses [ 42 ] . This further underscores the complex and bidirectional relationship between AF and stroke. The logistic regression analysis conducted in this study revealed that CHA 2 DS 2 -VASc ≥ 2, LASr, and LAAVImax were independent risk factors for CES in patients with NVAF. However, the predictive efficacy of the CHA 2 DS 2 -VASc score in identifying AF-related strokes exhibited certain limitations. Mao et al. [ 43 ] found that the predictive efficacy of LAA dispersion could be improved when combined with CHA 2 DS 2 -VASc, suggesting that LAA dispersion could improve thromboembolic risk stratification in patients with NVAF. The integration of imaging parameters with conventional clinical scales has the potential to enhance the identification of individuals at risk of stroke, decrease the incidence of AF-related strokes, and improve overall prognosis.Maheshwari et al [ 44 ] evaluated the relationship between LA function and size and CES, and the results showed that the combination of the LASr and the CHA 2 DS 2 -VASc scores improved the efficacy of predicting stroke, which is in agreement with the results of this study. LASr can detect alterations in LA function more promptly than LAEF, a capability crucial for sustaining the LV diastolic filling pressure gradient and mitigating the risk of stroke. Cao Xuesong et al [ 45 ] assessed the correlation between LAA maximal volume (LAAVmax) and CES by TEE and also demonstrated that LAAVmax is an influential factor in CES, similar to the results of the present study. In AF, the LAA undergoes dilation, increased volume, and heightened stiffness, which collectively exacerbate the stasis of blood flow and significantly contribute to the risk of stroke. The ROC curve analysis conducted in this study revealed that the predictive efficacy of LAAVImax was superior to that of both CHA 2 DS 2 -VASc ≥ 2 and LASr. Furthermore, the combined metrics of CHA 2 DS 2 -VASc ≥ 2, LASr, and LAAVImax exhibited the highest predictive efficacy among all the evaluated measures. Bieging et al [ 46 ] explored the correlation between LA and LAA shape parameters and stroke. The results indicated that LAA shape parameters exhibited a greater advantage in predicting stroke risk. For high-risk individuals with CHA2DS2-VASc ≥ 2, transesophageal evaluation of LAA function is recommended. LAA function is directly linked to thrombosis, while LA function provides a broader indication of overall cardiac remodeling.Simultaneous assessment of LA and LAA function enhances predictive performance, and integrating the scoring system with ultrasound parameters further boosts predictive accuracy. This study harbors several limitations. Firstly, it is a single-center investigation with a modest sample size. Secondly, residual confounders from other etiologies of CES remain present. Thirdly, the study has not stratified stroke risk based on the CHA 2 DS 2 -VASc scoring system, which could provide deeper insights into the structural-functional changes in the LA and LAA among individuals with varying degrees of stroke risk-low, intermediate, and high. Moving forward, it is imperative to extend the follow-up period to elucidate the correlations between LA and LAA structure, function, and clinical prognosis. Additionally, large-scale, multi-center studies should be undertaken to prospectively enroll a broader spectrum of patients with different types of AF, thereby enhancing the predictive accuracy of the model. Conclusion The structure and function of the LA and LAA are altered in patients with NVAF, with more severe functional reductions observed in those with CES. The CHA 2 DS 2 -VASc ≥ 2, LASr, and LAAVImax are independent risk factors for CES in NVAF patients. LASr and LAAVImax prove to be more effective predictors of CES in NVAF patients compared to the CHA 2 DS 2 -VASc score alone. The combined index of these three parameters exhibits the highest predictive efficacy, thereby enhancing the scoring system and aiding clinicians in more accurately identifying patients at elevated risk of stroke. Declarations Ethics approval and consent to participate The study has been approved by the Ethics Committee of the First Clinical Medical Science College of China Three Gorges University, & Yichang Central People’s Hospital Ethics Committee, Ethics No. 2024-183-01. All subjects had signed informed consent forms.All research involving human subjects is in accordance with the Helsinki Declaration. Consent for publication Not applicable. Data availability The datasets generated and analyzed during the current study are not publicly available due to patient privacy and scales copyright, but are available from the corresponding author on reasonable request. Funding This research was supported by the Natural Science Foundation of Hubei Province (Fund No. JCZRLH202500867). Author ’s contributions X.L. and S.H. wrote the main manuscript text. H.W. and X.L. calculated the data. D.S. and Z.A. analyzed data. Z.C. revised manuscript. All authors reviewed the manuscript. Acknowledgements The design of the experimental choices was based on patients with non-valvular atrial fibrillation. We acknowledge the contribution of all patients and their caregivers. Besides, ultrasound teachers also provided a lot of help and expressed their thoughts and views, which were considered and included in the project implementation. Competing interests The authors declare no conflict of interest. References Potter T B H, Tannous J, Vahidy F S. A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke[J]. Curr Atheroscler Rep, 2022,24(12):939-948. Collaborators G S. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021,20(10):795-820. Ma Q, Li R, Wang L, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990–2019: an analysis for the Global Burden of Disease Study 2019[J]. 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LAA\\u003c/p\\u003e\\n\\u003cp\\u003ens：\\u003cem\\u003eP\\u003c/em\\u003e＞0.05；*\\u003cem\\u003eP\\u003c/em\\u003e＜0.05；**\\u003cem\\u003eP\\u003c/em\\u003e＜0.01；***\\u003cem\\u003eP\\u003c/em\\u003e ＜0.005；****\\u003cem\\u003eP\\u003c/em\\u003e＜0.001\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage7.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7888856/v1/f1b84b62727c77701d15e029.png\"},{\"id\":97137790,\"identity\":\"4d7f77ef-f410-4c0a-a9d2-2c7bf6716d5e\",\"added_by\":\"auto\",\"created_at\":\"2025-12-01 09:58:10\",\"extension\":\"png\",\"order_by\":8,\"title\":\"Figure 8\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":107285,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eFig.2-3\\u003c/strong\\u003e ROC curves of each risk factor predicting the occurrence of CES in NVAF\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage9.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7888856/v1/7e1fd6399d98de58495a5cc1.png\"},{\"id\":106808994,\"identity\":\"5827bf1e-a887-4437-b857-0efffd20c4fb\",\"added_by\":\"auto\",\"created_at\":\"2026-04-13 16:05:24\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2746629,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7888856/v1/c9decfbd-84bd-4d1c-9ab5-d4d33e71bd3c.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"RT-3DE TEE combined with STI to evaluate the correlation between left atrial and left auricular function and stroke in patients with non-valvular atrial fibrillation: a clinical investigation\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eStroke is an acute cerebrovascular disorder resulting from the sudden rupture or occlusion of cerebral blood vessels, causing impaired brain tissue perfusion and subsequent neuronal damage or necrosis\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e.Recent statistical data indicate that stroke has emerged as the second leading cause of death and the third leading cause of disability globally\\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e. Ischemic stroke constitutes over 80% of all stroke cases\\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e. Moreover, ischemic stroke resulting from cerebral artery embolism caused by dislodged emboli of cardiac origin, namely, cardiogenic embolic stroke (CES), constitutes approximately 20\\u0026ndash;30% of ischemic strokes. It is more severe, exhibits a higher recurrence rate, and has a poorer prognosis\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR5 CR6\\\" citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e. Atrial fibrillation (AF) stands as the most significant risk factor for CES, and clinical investigations have demonstrated that strokes associated with AF constitute over 79% of all CES cases\\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e. Non-valvular atrial fibrillation (NVAF), as the principal subtype, results in a five-fold elevation in the risk of ischemic stroke when compared to individuals in sinus rhythm\\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. The CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc scoring system has been extensively employed to stratify the stroke risk in patients with AF and to direct the anticoagulation therapy\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR12\\\" citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e. Nevertheless, a greater number of studies have demonstrated that the structural and functional parameters of the left atrial (LA) and left atrial appendage (LAA) can effectively forecast the occurrence of AF-related stroke and might be superior to the CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc scoring system\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR15\\\" citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/sup\\u003e. The CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc scoring system solely depends on the patient's clinical parameters and does not integrate the functional imaging parameters of the LA and LAA, which are closely associated with the occurrence of stroke. Consequently, the accuracy of stroke risk assessment for patients with clinically abnormal cardiac function and low scores requires improvement. In patients with AF, the LA and LAA undergo pathological alterations as a result of hemodynamic disturbances and abnormal functional remodeling, which in turn lead to cardiomyocyte damage and a hypercoagulable state of the blood.Owing to the distinctive, narrow, and curved structure of the LAA, research findings have indicated that approximately 90% of thrombi in strokes associated with AF originate from the LAA\\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e.Furthermore, structural and functional abnormalities of the LA also increase the risk of thrombosis. Numerous studies have demonstrated that the structure and function of both the LA and LAA can be investigated as potential risk factors for stroke in patients with AF\\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/sup\\u003e. Two-dimensional speckle tracking imaging (2D-STI) offers a non-invasive method to monitor myocardial speckle motion, thereby indicating early functional alterations in the LA and LAA. This technique enables the acquisition of key parameters, including atrial strain and strain rate. Real-time three-dimensional echocardiography (RT-3DE) enables visualization and dynamic presentation of the three-dimensional structure of the atria, and acquires parameters associated with atrial volume and function\\u003csup\\u003e[\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e. Despite the distinct benefits offered by each technique, there is a notable scarcity of studies that have integrated RT-3DE with 2D-STI for a thorough and comprehensive evaluation.This integrated assessment approach is anticipated to offer a more thorough predictor for evaluating stroke risk in patients with AF, thereby enhancing the predictive accuracy of the CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc scoring system.\\u003c/p\\u003e\\u003cp\\u003eThis study aimed to utilize RT-3DE in conjunction with 2D-STI to analyze the structural and functional alterations in the LA and LAA among NVAF patients with concurrent CES. Additionally, it sought to investigate the mechanisms and risk factors underlying the onset of CES in NVAF patients. The ultimate goal was to enhance early risk stratification, complement the CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc scoring system, and provide guidance for personalized treatment strategies to improve patient outcomes.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eStudy population\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFrom September 2022 to October 2024, 125 NVAF patients without LAA thrombus were enrolled from the Department of Cardiology at our hospital, and their LA and LAA ultrasound images were collected. The mean follow-up duration for all patients was 9.1 months, with the primary endpoint being the occurrence of CES. Based on the presence or absence of CES during the follow-up period, patients were categorized into the NVAF group (n=70, no CES) and the NVAF+CES group (n=55, with CES). Additionally, 96 patients in sinus rhythm during the same period were selected as a control group. This study received approval from the Medical Ethics Committee of our hospital (Approval number: 2024-183-01), and all participants provided signed informed consent.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInclusion and exclusion criteria\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePatients fulfilled the diagnostic criteria for NVAF according to the 2024 European Society of Cardiology (ESC) Guidelines on the Management of Atrial Fibrillation\\u003csup\\u003e[21]\\u003c/sup\\u003e, and those with CES adhered to the Chinese Expert Consensus on the Diagnosis of Cardiogenic Stroke (2020)\\u003csup\\u003e[22]\\u003c/sup\\u003e. All participants provided signed informed consent. Excluded from the study were patients with congenital heart disease, cardiomyopathy, organic mitral valve disease, or severe heart failure; those with pulmonary embolism, deep venous thrombosis, or other conditions leading to stroke; individuals with carotid artery plaque stenosis of 75% or more, or vulnerable carotid plaques as confirmed by ultrasound; patients with severe hepatic or renal insufficiency, or malignant tumors; those with incomplete clinical or imaging data; and subjects experiencing atrial fibrillation during the ultrasound examination or whose image quality was insufficient for analysis by post-processing software.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInstrumentation\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eA Philips EPIQ CVx color Doppler ultrasound diagnostic machine, featuring an X5-1 three-dimensional matrix probe operating at 1-5 MHz, was employed in this study. It was equipped with a real-time three-dimensional full volume imaging system and a QLAB 13.0 post-processing workstation.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRoutine echocardiographic parameter acquisition\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSubjects were positioned in the left lateral decubitus, instructed to breathe calmly, and two-dimensional echocardiography was conducted following simultaneous connection to the ECG. The left atrial anteroposterior diameter (LAD) was measured in the parasternal long-axis view. The left ventricular end-diastolic diameter (LVEDD) was assessed in the same view using M-mode ultrasound. The left ventricular ejection fraction (LVEF) was determined via the biplane Simpson\\u0026apos;s method. Pulsed Doppler measurements were obtained in the apical 4-chamber view to quantify the early peak flow rate of mitral valve filling (E) during early diastole. The pulsed Doppler sampling volume was positioned at the mitral annulus, both on the septal side and the lateral wall side of the left ventricle, to capture the mean peak early diastolic mitral annular velocity (e\\u0026apos;), with the E/e\\u0026apos; ratio subsequently calculated. Four consecutive cardiac cycle images were recorded and stored, and the aforementioned parameters were averaged by repeating the measurements three times.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2D-STI parameter acquisition\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe apical four-chamber heart image displayed on the left atrial wall was selected and imported into the QLAB 13.0 post-processing workstation. The AutoStrain LA mode was then chosen to manually adjust the left atrial endocardium, identifying three key points on both sides of the mitral valve and at the atrial apex to ensure the endocardial envelope was fully delineated. The software subsequently computed the left atrial reservoir strain (LASr), left atrial duct strain (LAScd), and left atrial auxiliary pump strain (LASct), as illustrated in Fig.1-1. These parameters were measured three times to obtain an average value.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRT-3DE parameter acquisition\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe apical 4-chamber heart section was selected, and the real-time 3D volumetric imaging system was activated once the endocardium of the left atrium was clearly visualized. Continuous acquisition of dynamic images from at least 4 cardiac cycles was performed, which were subsequently imported into the QLAB 13.0 post-processing workstation. The 3DQ Advance mode was selected, and the sampling point was positioned on the endocardial surface of the left atrium. The morphology of the left atrium was adjusted to generate the time-volume curve. From this curve, the left atrial maximum volume (LAVmax), left atrial presystolic volume (LAVpre), and left atrial minimum volume (LAVmin) were derived, as illustrated in Fig.1-2. Following body surface area (BSA) standardization, the left atrial maximum volume index (LAVImax), left atrial presystolic volume index (LAVIpre), and left atrial minimum volume index (LAVImin) were obtained. Additionally, the left atrial ejection fraction (LVEF), left atrial expansion index (LAEI), left atrial passive ejection fraction (pasEF), and left atrial active ejection fraction (actEF) were calculated. The mean values of these parameters were determined by averaging three repeated measurements.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTransesophageal echocardiographic parameter acquisition\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA Philips EPIQ CVx color Doppler ultrasound machine equipped with an X8-2t three-dimensional matrix probe operating at 2-7 MHz was utilized. The patient underwent transesophageal echocardiography under preoperative anesthesia while positioned in the left lateral decubitus position. Two-dimensional dynamic images of more than four cardiac cycles, clearly depicting the left auricle, were stored at a 90\\u0026deg;\\u0026nbsp;view. Simultaneously, three-dimensional dynamic images of the LAA were acquired using the 3D-ZOOM imaging mode, with the images captured over four cycles.The left atrial appendage diameter (LAAD) and left atrial appendage height (LAAH) were measured at 0\\u0026deg;, 45\\u0026deg;, 90\\u0026deg;, and 135\\u0026deg;, respectively, and the average values were computed. The left atrial appendage emptying velocity (LAA-EV) and left atrial appendage filling velocity (LAA-FV) were assessed using spectral Doppler at a 90\\u0026deg;\\u0026nbsp;section of the left atrium. The 2D dynamic images of the left atrium were imported into the QLAB 13.0 post-processing workstation to determine the left atrial appendage strain (LAAS), as illustrated in Fig.1-3.For the 3D full-volume dynamic image of the left auricle, the 3DQ Advance mode was employed to calculate the left atrial appendage maximum volume (LAAVmax), left atrial appendage minimum volume (LAAVmin), and left atrial appendage ejection fraction (LAAEF), as shown in Fig.1-4. These volumes were normalized to body surface area to derive the left atrial appendage maximum volume index (LAAVImax) and left atrial appendage minimum volume index (LAAVImin).Three-dimensional LA image analysis was conducted using the GI-3DQ plug-in, and the left atrial appendage maximal orifice area (LAA-OAmax) was measured at end-diastole following adjustment of the red, green, and blue planes, as depicted in Fig.1-5. All parameters were measured three times, and the mean values were recorded.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical data acquisition\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMedical records were reviewed to obtain the following data for each subject: sex, age, height, weight, creatinine levels, triglyceride levels, D-dimer levels, LDL cholesterol levels, history of hypertension, history of diabetes mellitus, history of previous stroke, body mass index (BMI), body surface area (BSA), and CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc score.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSPSS 27.0 and GraphPad Prism 9.4.1 statistical software were employed for data analysis. Measurements adhering to a normal distribution were presented as x̄\\u0026plusmn;s. One-way analysis of variance (ANOVA) was utilized to compare means across multiple groups, with the LSD method applied for pairwise comparisons between groups. Data not conforming to normal distribution were expressed as M (P25, P75), and group comparisons were conducted using the non-parametric rank sum test. Count data were represented as cases and rates, with inter-group comparisons performed via the chi-square test or Fisher\\u0026apos;s exact probability method. Independent risk factors for CES in NVAF patients were identified through univariate and multivariate logistic regression analyses. The Receiver Operating Characteristic (ROC) curve was generated to assess the predictive efficacy of each factor for CES occurrence in NVAF patients, and the area under the curve (AUC) was computed. And \\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 denoted statistical significance.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eConsistent evaluation of structural and functional parameters of the LA and LAA\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTable 1 illustrates the application of RT-3D and 2D-STI for the quantitative analysis of intra- and inter-observer agreement evaluations concerning the structural-functional parameters of the LA and LAA, specifically LASr, LAScd, LASct, LAVImax, LAVIpre, LAVImin, LAAS, LAAVImax, LAAVImin, and LAA-OA. The findings demonstrated a high degree of intra- and inter-observer reproducibility for these parameters.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 1:\\u003c/strong\\u003e Consistent evaluation of structural and functional parameters of the LA and LAA\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"562\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eParameter\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eICC \\u0026nbsp; \\u0026nbsp; 95%CI \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 239px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eICC \\u0026nbsp; \\u0026nbsp; 95%CI \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cem\\u003eP\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLASr\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.418-0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.73-0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAScd\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.74-0.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.87\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.57-0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLASct\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.87\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.47-0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.68-0.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAVImax\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.86\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.53-0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.60-0.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAVIpre\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.74-0.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.87\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.42-0.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAVImin\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.92\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.67-0.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.86\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.42-0.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAAS\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.80\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.41-0.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.85\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.52-0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAAVImax\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.43-0.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.92\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.72-0.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAAVImin\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.63-0.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.77-0.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAA-OAmax\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 46px;\\\"\\u003e\\n \\u003cp\\u003e0.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0.67-0.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e0.61-0.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 87px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eLASr, left atrial reservoir strain; LAScd, left atrial duct strain; LASct, left atrial auxiliary strain; LAVImax, left atrial maximum volume index; LAVIpre, left atrial presystolic volume index; LAVImin, left atrial minimum volume index; LAAS, left atrial appendage strain; LAAVImax, left atrial appendage maximum volume index; LAAVImin, left atrial appendage minimum volume index; LAA-OAmax, left atrial appendage maximal orifice area; \\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 indicates statistical significance.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eComparison of general clinical information\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere were no statistically significant differences among the three groups regarding gender, age, BMI, BSA, TG, Cr, D-dimer, LDL, systolic pressure, and diastolic pressure (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026gt;0.05). However, compared with the control group, the NVAF+CES group exhibited higher CK-MB levels and a greater proportion of individuals with a CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026ge;2, which were statistically significant (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). Additionally, when compared to the NVAF group, the NVAF+CES group had a larger proportion of individuals with a CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026ge;2, and this difference was also statistically significant (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). See Table 2.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eComparison of general clinical data parameters\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"656\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eParameter\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eControl group\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003en=96\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNVAF\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003en=70\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNVAF+CES\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003en=55\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eF/\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003cem\\u003ec\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003cem\\u003e\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eMan/Female\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e46/50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e37/33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e27/28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.409\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.815\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eAge (years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e54.56\\u0026plusmn;12.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e55.76\\u0026plusmn;8.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e56.00\\u0026plusmn;7.65\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.439\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.645\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eBMI（kg/m\\u003csup\\u003e2\\u003c/sup\\u003e）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e23.60\\u0026plusmn;2.85\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e24.45\\u0026plusmn;2.76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e23.82\\u0026plusmn;2.84\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e1.922\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.149\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eBSA（m\\u003csup\\u003e2\\u003c/sup\\u003e）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e1.72\\u0026plusmn;0.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1.70\\u0026plusmn;0.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e1.69\\u0026plusmn;0.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.368\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.693\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eCK-MB（ng/ml）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.74\\u0026plusmn;0.19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e0.76\\u0026plusmn;0.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e0.81\\u0026plusmn;0.23\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e3.410\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.036\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eTG（mmol/L）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e1.18\\u0026plusmn;0.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1.17\\u0026plusmn;0.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e1.10\\u0026plusmn;0.27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.574\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.564\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eCr（umol/L）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e73.05\\u0026plusmn;4.28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e73.80\\u0026plusmn;12.21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e74.09\\u0026plusmn;9.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.294\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.745\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eD-dimer（mg/L）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.29\\u0026plusmn;0.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e0.34\\u0026plusmn;0.31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e0.41\\u0026plusmn;0.38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e1.537\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.058\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eLDL（mmol/L）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e2.12\\u0026plusmn;0.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e2.19\\u0026plusmn;0.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e2.24\\u0026plusmn;0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.764\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.106\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eSystolic pressure（mmHg）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e118.36\\u0026plusmn;4.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e119.54\\u0026plusmn;18.89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e119.49\\u0026plusmn;3.25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.291\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.747\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eDiastolic pressure （mmHg）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e75.72\\u0026plusmn;6.16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e76.80\\u0026plusmn;15.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e77.95\\u0026plusmn;4.72\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.860\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.425\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eCHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e8.460\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.015\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;2（n/％）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e64（66.7）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e45（64.2）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e24（42.9）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;2（n/％）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e32（33.3）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e25（35.7）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e31（44.3）\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eBMI, body mass index; BSA, body surface area; CK-MB, creatine kinase isoenzyme; TG, triglycerides; Cr, creatinine; LDL, low-density lipoprotein; CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc, atrial fibrillation embolism risk score. Statistical significance was defined as \\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05, with differences marked as follows: \\u003cem\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 (vs. control group) and \\u003cem\\u003e\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/em\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 (vs. NVAF group).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eComparison of conventional electrocardiogram parameters\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe inter-group comparison revealed that, compared to the control group, both the NVAF and NVAF+CES groups exhibited elevated levels of LAD, LVEDD, E, and E/e\\u0026apos;, along with reduced LVEF, with these differences being statistically significant (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). Additionally, when compared to the NVAF group, the NVAF+CES group demonstrated a further increase in LAD, also with statistically significant differences (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). See Table 3.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eComparison of conventional echocardiographic parameters\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"588\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eParameter\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eControl group\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（n=96）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNVAF\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（n=70）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 123px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNVAF+CES\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（n=55）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eF\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003eLAD（mm）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e35.47\\u0026plusmn;3.16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e40.54\\u0026plusmn;6.34\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 123px;\\\"\\u003e\\n \\u003cp\\u003e44.40\\u0026plusmn;6.21\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e55.223\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003eLVEDD（mm）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e44.15\\u0026plusmn;3.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e46.57\\u0026plusmn;4.42\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 123px;\\\"\\u003e\\n \\u003cp\\u003e47.20\\u0026plusmn;3.59\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e13.352\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003eE（m/s）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e0.70\\u0026plusmn;0.015\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e0.77\\u0026plusmn;0.22\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 123px;\\\"\\u003e\\n \\u003cp\\u003e0.79\\u0026plusmn;0.016\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e9.468\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.027\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003eE/e\\u0026rsquo;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e9.51\\u0026plusmn;0.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e10.73\\u0026plusmn;3.59\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 123px;\\\"\\u003e\\n \\u003cp\\u003e12.34\\u0026plusmn;4.37\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e15.486\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003eLVEF（％）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e64.13\\u0026plusmn;3.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e62.17\\u0026plusmn;5.48\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 123px;\\\"\\u003e\\n \\u003cp\\u003e60.29\\u0026plusmn;6.02\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e11.670\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eLAD, left atrium anteroposterior diameter; LVEDD, left ventricular end-diastolic diameter; E, early peak velocity of blood flow during diastolic filling of the left ventricle; E/e\\u0026apos;, ratio of early peak velocity of mitral inflow (E) to early diastolic peak velocity of mitral annular tissue (e\\u0026apos;); LVEF, left ventricular ejection fraction; LASr, left atrial reservoir strain; LAScd, left atrial duct strain. \\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 indicates statistically significant differences, marked as follows: \\u003cem\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 (vs. control group) and \\u003cem\\u003e\\u003csup\\u003eb\\u003c/sup\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 (vs. NVAF group).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eComparison of structural and functional parameters of the LA\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCompared to the control group, both the NVAF and NVAF+CES groups exhibited elevated LAVImax, LAVIpre, and LAVImin values (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05), whereas LASr, LAScd, LASst, LAEI, LAEF, and pasEF levels significantly decreased (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). Furthermore, the NVAF+CES group showed a statistically significant reduction in actEF relative to the control group (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). When contrasted with the NVAF group, the NVAF+CES group demonstrated higher LAVImax, LAVIpre, and LAVImin values (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05) and lower LASr, LAScd, LASst, and LAEI levels, all with statistically significant differences (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). See Table 4 and Fig.2-1.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4\\u003c/strong\\u003e Comparison of structural and functional parameters of the LA\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"599\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eParameter\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eControl group\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003en=96\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNVAF\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003en=70\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNVAF+CES\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003en=55\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eF\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLASr（％）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e30.02\\u0026plusmn;3.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e22.59\\u0026plusmn;7.68\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e17.53\\u0026plusmn;3.16\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e110.534\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAScd（％）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e17.36\\u0026plusmn;2.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e13.94\\u0026plusmn;2.80\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e12.23\\u0026plusmn;2.33\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e47.399\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLASct（％）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e12.79\\u0026plusmn;1.86\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e10.16\\u0026plusmn;2.09\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e9.25\\u0026plusmn;1.56\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e24.806\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAVImax（ml/m\\u003csup\\u003e2\\u003c/sup\\u003e）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e27.57\\u0026plusmn;4.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e33.41\\u0026plusmn;7.64\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e36.97\\u0026plusmn;5.90\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e49.252\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAVIpre（ml/m\\u003csup\\u003e2\\u003c/sup\\u003e）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e21.67\\u0026plusmn;3.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e28.54\\u0026plusmn;6.84\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e32.29\\u0026plusmn;5.24\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e80.876\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAVImin（ml/m\\u003csup\\u003e2\\u003c/sup\\u003e）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e17.66\\u0026plusmn;3.34\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e24.31\\u0026plusmn;6.22\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e28.66\\u0026plusmn;5.07\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e51.137\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAEI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e0.57\\u0026plusmn;0.12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e0.40\\u0026plusmn;0.09\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e0.30\\u0026plusmn;0.07\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e44.908\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.039\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eLAEF（％）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e36.55\\u0026plusmn;5.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e27.46\\u0026plusmn;5.12\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e26.62\\u0026plusmn;3.92\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e103.349\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003epasEF（％）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e28.43\\u0026plusmn;4.27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e24.68\\u0026plusmn;4.52\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e23.66\\u0026plusmn;3.18\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e29.213\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003eactEF（％）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e19.82\\u0026plusmn;5.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 106px;\\\"\\u003e\\n \\u003cp\\u003e19.08\\u0026plusmn;5.90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e17.39\\u0026plusmn;3.96\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e3.682\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.027\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eLASr, left atrial reservoir strain; LAScd, left atrial duct strain; LASct, left atrial auxiliary pump strain; LAVImax, left atrial maximum volume index; LAVIpre, left atrial presystolic volume index; LAVImin, left atrial minimum volume index; LAEI, left atrial expansion index; LAEF, left atrial ejection fraction; pasEF, left atrial passive ejection fraction; actEF, left atrial passive ejection fraction.The positive/negative sign of strain values denotes direction, not magnitude. For comparative ease, all strain values in this study are presented as absolute values. Statistical significance (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05) is indicated as follows: \\u003cem\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 (vs. control group) and\\u003csup\\u003e\\u0026nbsp;\\u003cem\\u003eb\\u003c/em\\u003e\\u003c/sup\\u003e\\u003cem\\u003eP\\u0026nbsp;\\u003c/em\\u003e\\u0026lt; 0.05 (vs. NVAF group).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eComparison of structural and functional parameters of the LAA\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCompared to the control group, both the NVAF and NVAF+CES groups exhibited increased LAAD, LAAH, LAA-OAmax, LAAVImax, and LAAVImin (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). Conversely, LAA-EV, LAA-FV, LAAS, and LAAEF showed significant decreases (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). In the NVAF+CES group, LAAD, LAA-OAmax, LAAVImax, and LAAVImin were all higher than those in the NVAF group (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05), whereas LAAS decreased, with all these differences being statistically significant (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). See Table 5 and Fig.2-2.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 5\\u003c/strong\\u003e Comparison of structural and functional parameters of the LAA\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"627\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eParameter\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eControl group\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003en=96\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNVAF\\u003c/strong\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003en=70\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNVAF+CES\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003en=55\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eF\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003eLAAD（cm）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e1.82\\u0026plusmn;0.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e2.26\\u0026plusmn;0.47\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e2.56\\u0026plusmn;0.41\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e60.470\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003eLAAH（cm）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e2.70\\u0026plusmn;0.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e3.12\\u0026plusmn;0.54\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e3.31\\u0026plusmn;0.46\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e39.379\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003eLAA-EV（cm/s）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e47.74\\u0026plusmn;3.71\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e40.67\\u0026plusmn;10.80\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e38.85\\u0026plusmn;5.98\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e33.489\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003eLAA-FV（cm/s）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e49.18\\u0026plusmn;5.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e39.38\\u0026plusmn;9.01\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e39.67\\u0026plusmn;4.69\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e55.982\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003eLAAS（％）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e8.50\\u0026plusmn;1.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e7.03\\u0026plusmn;1.75\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e6.03\\u0026plusmn;1.09\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e63.853\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003eLAAVImax（ml/m\\u003csup\\u003e2\\u003c/sup\\u003e）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e3.40\\u0026plusmn;0.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e4.66\\u0026plusmn;1.13\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e5.74\\u0026plusmn;0.57\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e162.946\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003eLAAVImin（ml/m\\u003csup\\u003e2\\u003c/sup\\u003e）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e1.93\\u0026plusmn;0.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e3.18\\u0026plusmn;0.67\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e3.99\\u0026plusmn;0.92\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e178.910\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003eLAAEF（％）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e40.17\\u0026plusmn;4.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e31.26\\u0026plusmn;9.69\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e30.86\\u0026plusmn;7.26\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e42.442\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 159px;\\\"\\u003e\\n \\u003cp\\u003eLAA-OAmax（cm\\u003csup\\u003e2\\u003c/sup\\u003e）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e3.79\\u0026plusmn;0.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 112px;\\\"\\u003e\\n \\u003cp\\u003e5.08\\u0026plusmn;2.12\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 111px;\\\"\\u003e\\n \\u003cp\\u003e6.01\\u0026plusmn;0.99\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e50.581\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eLAAD, left atrial appendage diameter; LAAH, left atrial appendage height; LAA-EV, left atrial appendage emptying velocity; LAAFV, left atrial appendage filling velocity; LAAS, left atrial appendage strain; LAAVImax, left atrial appendage maximum volume index; LAAVImin, left atrial appendage minimum volume index; LAAEF, left atrial appendage ejection fraction; LAA-OAmax, left atrial appendage maximum office area. The positive/negative sign of strain values denotes direction, not magnitude. For comparative purposes, all strain values in this study are presented as absolute values. Statistical significance (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05) is indicated as follows: \\u003cem\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 (vs. control group) and \\u003cem\\u003e\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/em\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05 (vs.\\u0026nbsp;NVAF\\u0026nbsp;group).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAnalysis of risk factors for CES in NAVF patients\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOne-way factor analysis revealed that CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026ge;2, LASr, LAScd, LASst, LAVImax, LAVImin, LAVIpre, LAAS, LAAVImax, and LAA-OA were significantly associated with NVAF-induced cardioembolic stroke (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05). Multivariate logistic regression analysis further identified CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026ge;2, LASr, and LAAVImax as independent risk factors for CES in NVAF patients. See Table 6.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 6\\u0026nbsp;\\u003c/strong\\u003eAnalysis of single and multiple factors for CES in NVAF patients\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"531\\\" class=\\\"fr-table-selection-hover\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eParameter\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 205px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOne factor analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 200px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMultiple factor Logistic analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\u003cstrong\\u003eOR（95% CI）\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003eP\\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 200px;\\\"\\u003e\\u003cstrong\\u003eOR（95% CI）\\u003c/strong\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 200px;\\\"\\u003eP\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eCHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026ge;2\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e1.208（0.097～0.449）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e1.163（1.051～1.517）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.002\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLASr（％）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e0.866（0.805～0.931）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e＜0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e0.853（0.760～0.957）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.015\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAScd（％）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e0.776（0.669～0.900）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e＜0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLASct（％）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e0.768（0.627～0.940）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e0.011\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAVImax（ml/m\\u0026sup2;）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e1.077（1.021～1.137）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e0.007\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAVIpre（ml/m\\u0026sup2;）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e1.104（1.037～1.174）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e0.002\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAVImin（ml/m\\u0026sup2;）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e1.143（1.065～1.226）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAEI\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e0.803（0.735～1.078）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e0.264\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAAD（cm）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e1.239（1.150～1.342）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e0.069\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAAS（％）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e0.721（0.654～0.869）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e＜0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAAVImax\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e3.788（2.218～6.434）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e＜0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e2.520（1.198～5.298）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.015\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAAVImin（ml/m\\u003csup\\u003e2\\u003c/sup\\u003e）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e3.704（2.123～6.464）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e0.149\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 126px;\\\"\\u003e\\n \\u003cp\\u003eLAA-OAmax（cm\\u003csup\\u003e2\\u003c/sup\\u003e）\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 25.9966%;\\\"\\u003e\\n \\u003cp\\u003e1.389（1.100～1.753）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.058%;\\\"\\u003e\\n \\u003cp\\u003e0.006\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 146px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eLASr, left atrial reservoir strain; LAScd, left atrial duct strain; LASct: Left atrial auxiliary pump strain; LAVImax, left atrial maximum volume index; LAVIpre, left atrial presystolic volume index; LAVImin, left atrial minimum volume index; LAEI, left atrial expansion index; LAAD, left atrial appendage diameter; LAAS, left atrial appendage strain; LAAVImax, left atrial appendage maximum volume index; LAAVImin, left atrial appendage minimum volume index; LAAEF, left atrial appendage ejection fraction; LAA-OAmax, left atrial appendage maximum orifice area. \\u003cem\\u003eP\\u003c/em\\u003e \\u0026lt;0.05 indicates a statistically significant difference.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eROC curve analysis\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eROC curve analysis revealed that the area under the curve (AUC) for predicting CES in AF patients was 0.685, 0.720, and 0.803 for CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026ge;2, LASr, and LAAVImax, respectively. The corresponding cutoff values were 22.62% for CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026ge;2, and 4.98 ml/m\\u0026sup2; for LASr and LAAVImax, with sensitivities of 72.7%, 91.2%, and 90.9%, and specificities of 64.3%, 47.1%, and 62.9%, respectively. The combined predictor of LASr and LAAVImax yielded an AUC of 0.809, with a sensitivity of 92.7% and specificity of 62.9%. In contrast, the combined predictor of CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026ge;2, LASr, and LAAVImax demonstrated an AUC of 0.854, sensitivity of 90.9%, and specificity of 68.6%. See Table 7 and Fig.2-3.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 7\\u003c/strong\\u003e ROC Analysis of Risk Factors\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"586\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRisk factor\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAUC\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95\\u003c/strong\\u003e\\u003cstrong\\u003e％\\u003c/strong\\u003e\\u003cstrong\\u003eCI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOptimal cut-off value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSensitivity (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSpecificity (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48px;\\\"\\u003e\\n \\u003cp\\u003e0.685\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e0.590～0.780\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e/\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e72.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e64.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eLASr\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48px;\\\"\\u003e\\n \\u003cp\\u003e0.720\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e0.629～0.811\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e22.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e91.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e47.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eLAAVImax\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48px;\\\"\\u003e\\n \\u003cp\\u003e0.803\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e0.726～0.881\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e4.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e90.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e62.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eLAAVImax+ LASr\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 48px;\\\"\\u003e\\n \\u003cp\\u003e0.809\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e0.732～0.886\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e/\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e92.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e62.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCombined indicators*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 48px;\\\"\\u003e\\n \\u003cp\\u003e0.854\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e0.788～0.919\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e/\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e90.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 103px;\\\"\\u003e\\n \\u003cp\\u003e68.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCombined indicator*\\u003c/strong\\u003e: CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc, LAAVImax, LASr combined\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe LAA, an embryonic remnant of the primitive LA, possesses distinct anatomical and functional attributes. It exhibits autonomous systolic and diastolic functions, serves as a \\\"pressure regulator\\\" for the LA, adapts to volumetric changes, and secretes natriuretic peptides\\u003csup\\u003e[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e. The diminished effective contraction of the LA and LAA in patients with AF, coupled with their narrow tubular anatomy, predisposes the LAA to hypercoagulation and blood stasis, thereby increasing the risk of thrombosis. Consequently, the LAA serves as the primary source of CES\\u003csup\\u003e[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]\\u003c/sup\\u003e. The morphology of the LAA and its clinical significance remain subjects of ongoing debate. The shape of the LAA is typically categorized into distinct forms such as chicken wing, windward band, cactus, and cauliflower\\u003csup\\u003e[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e.In patients with AF, the LA and LAA experience a loss of effective contraction. Additionally, the narrow, tubular anatomy of the LAA predisposes it to hypercoagulation and blood stasis, thereby increasing the risk of thrombosis. Qi Shuyuan et al \\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003efound that non-chicken-wing LAA morphology was an independent risk factor for thromboembolic risk in AF patients with CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026thinsp;\\u0026le;\\u0026thinsp;1. However, Xinyan Wang et al\\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e found that LAA morphology was not a risk factor for stroke in patients with NVAF, which was similar to the findings of Wu et al \\u003csup\\u003e[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]\\u003c/sup\\u003e, suggesting that there was no significant correlation between LAA morphology and stroke risk in patients with NVAF. This discrepancy can be attributed to the subjective nature of LAA morphological classification and the limited predictive value of anatomical data. Consequently, a comprehensive assessment necessitates the integration of both institutional and functional parameters of the LAA. 2D-STI is executed by tracking the speckle motion of myocardial tissue, thereby obtaining myocardial motion velocities, strain rates, and strain parameters\\u003csup\\u003e[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]\\u003c/sup\\u003e. RT-3DE can directly visualize the three-dimensional anatomical structure of the LA and LAA, and perform precise quantitative analysis of their functional status, which holds significant clinical value. Transesophageal real-time 3D echocardiography (RT-3D TEE) imaging boasts high resolution and enables the observation of three-dimensional anatomical images of the LAA from various angles. Based on this, the study employed RT-3D TEE in conjunction with 2D-STI to examine the structure and function of the LA and LAA in NVAF patients. Additionally, it aimed to investigate the risk factors and underlying mechanisms of CES in NVAF patients, thereby providing a crucial reference for the prevention and treatment of CES.\\u003c/p\\u003e\\u003cp\\u003eThe results of this study revealed that LASr, LAScd, and LASct were significantly lower, whereas LAVImax, LAVIpre, and LAVImin were markedly higher in the NVAF and NVAF\\u0026thinsp;+\\u0026thinsp;CES groups compared to the control group, with all differences achieving statistical significance (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Conversely, the NVAF\\u0026thinsp;+\\u0026thinsp;CES group exhibited reduced LA strain and elevated volume index relative to the NVAF group. These findings suggest that AF adversely impacts LA function, resulting in diminished strain and increased volume across all periods, with these changes being particularly pronounced in patients within the stroke group. Cardiomyocytes in patients with AF undergo atrial remodeling in response to stressor stimulation\\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e, leading to increased LA myocardial fibrosis, enlarged volume, diminished compliance, and weakened contraction, aligning with the findings of this study. Shao Li et al \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e showed that LA structure-function remodeling in AF patients was also indicated. In general, LA regulates left ventricular (LV) filling through storage, conduit, and co-pumping phases to promote LV blood circulation. Blood from the systemic venous return is stored in the ventricle during systole. During early and mid-diastole, blood passively flows from the LA into the LV, which facilitates LV filling during late diastole through the contraction of LA.\\u003c/p\\u003e\\u003cp\\u003eThe study's findings revealed that the NVAF and NVAF\\u0026thinsp;+\\u0026thinsp;CES groups exhibited higher values for LAAD, LAAH, LAA-OAmax, LAAVImax, and LAAVImin compared to the control group. Conversely, LAA-EV, LAA-FV, LAAS, and LAAEF were lower in these groups than in the control group. All these differences were statistically significant (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). In the NVAFA\\u0026thinsp;+\\u0026thinsp;CES group, LAAD, LAA-OAmax, LAAVImax, and LAAVImin increased, and LAAS decreased, and the differences were statistically significant (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). It was observed that in patients with NVAF, the LAA volume expanded, the opening area enlarged, whereas the strain and ejection fraction diminished, and the LAA emptying and filling velocities reduced.The underlying cause of this phenomenon may be attributed to left heart remodeling induced by AF. During AF episodes, this remodeling impacts the LA and LAA cardiomyocytes, prompting fibrosis and altering myocardial compliance and stiffness. Consequently, this results in an enlarged LAA volume and diminished strain\\u003csup\\u003e[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]\\u003c/sup\\u003e. The LAA boasts superior compliance and enhanced blood storage capacity, attributed to its crucial function and unique anatomical structure\\u003csup\\u003e[\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e. In prolonged LV dysfunction, the compliance of the LAA diminishes, resulting in heightened dilatation and increased stiffness. This progression ultimately leads to structural and functional remodeling of both the LA and LAA.\\u003c/p\\u003e\\u003cp\\u003eCES represents a significant hazard, with its incidence steadily increasing\\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e, and AF emerges as its primary risk factor. This study delves into the mechanism of stroke in patients with NVAF. We conducted a comparative analysis of the structure and function of the LA and LAA between the NVAF group and the NVAF\\u0026thinsp;+\\u0026thinsp;CES group. Our findings indicate that the LA and LAA in patients with CES exhibit significantly reduced strain, increased volume, and diminished function. The mechanism underlying NVAF-induced CES is intricate. Research has demonstrated that blood flow stasis, endothelial damage, and structural remodeling due to AF collectively facilitate thrombosis. Notably, in 90% of AF patients, the thrombus is localized within the LAA\\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e. However, a study by Buckley et al\\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e found no difference in stroke risk between patients who received rhythm control therapy and those who did not. This implies that an inherent pro-thrombotic atrial matrix abnormality might precede the onset of AF. Atrial cardiomyopathy can be precipitated by factors such as age and diabetes, resulting in thrombosis even in the absence of arrhythmia. This condition interacts with AF, thereby heightening the risk of stroke\\u003csup\\u003e[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e. Many patients with cryptogenic stroke develop AF long after the initial event, a phenomenon potentially linked to post-stroke neurohumoral imbalances and inflammatory responses\\u003csup\\u003e[\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e. This further underscores the complex and bidirectional relationship between AF and stroke.\\u003c/p\\u003e\\u003cp\\u003eThe logistic regression analysis conducted in this study revealed that CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026thinsp;\\u0026ge;\\u0026thinsp;2, LASr, and LAAVImax were independent risk factors for CES in patients with NVAF. However, the predictive efficacy of the CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc score in identifying AF-related strokes exhibited certain limitations. Mao et al.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e found that the predictive efficacy of LAA dispersion could be improved when combined with CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc, suggesting that LAA dispersion could improve thromboembolic risk stratification in patients with NVAF. The integration of imaging parameters with conventional clinical scales has the potential to enhance the identification of individuals at risk of stroke, decrease the incidence of AF-related strokes, and improve overall prognosis.Maheshwari et al\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]\\u003c/sup\\u003e evaluated the relationship between LA function and size and CES, and the results showed that the combination of the LASr and the CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc scores improved the efficacy of predicting stroke, which is in agreement with the results of this study. LASr can detect alterations in LA function more promptly than LAEF, a capability crucial for sustaining the LV diastolic filling pressure gradient and mitigating the risk of stroke. Cao Xuesong et al\\u003csup\\u003e[\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e]\\u003c/sup\\u003e assessed the correlation between LAA maximal volume (LAAVmax) and CES by TEE and also demonstrated that LAAVmax is an influential factor in CES, similar to the results of the present study. In AF, the LAA undergoes dilation, increased volume, and heightened stiffness, which collectively exacerbate the stasis of blood flow and significantly contribute to the risk of stroke.\\u003c/p\\u003e\\u003cp\\u003eThe ROC curve analysis conducted in this study revealed that the predictive efficacy of LAAVImax was superior to that of both CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026thinsp;\\u0026ge;\\u0026thinsp;2 and LASr. Furthermore, the combined metrics of CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026thinsp;\\u0026ge;\\u0026thinsp;2, LASr, and LAAVImax exhibited the highest predictive efficacy among all the evaluated measures. Bieging et al\\u003csup\\u003e[\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e]\\u003c/sup\\u003e explored the correlation between LA and LAA shape parameters and stroke. The results indicated that LAA shape parameters exhibited a greater advantage in predicting stroke risk. For high-risk individuals with CHA2DS2-VASc\\u0026thinsp;\\u0026ge;\\u0026thinsp;2, transesophageal evaluation of LAA function is recommended. LAA function is directly linked to thrombosis, while LA function provides a broader indication of overall cardiac remodeling.Simultaneous assessment of LA and LAA function enhances predictive performance, and integrating the scoring system with ultrasound parameters further boosts predictive accuracy.\\u003c/p\\u003e\\u003cp\\u003eThis study harbors several limitations. Firstly, it is a single-center investigation with a modest sample size. Secondly, residual confounders from other etiologies of CES remain present. Thirdly, the study has not stratified stroke risk based on the CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc scoring system, which could provide deeper insights into the structural-functional changes in the LA and LAA among individuals with varying degrees of stroke risk-low, intermediate, and high. Moving forward, it is imperative to extend the follow-up period to elucidate the correlations between LA and LAA structure, function, and clinical prognosis. Additionally, large-scale, multi-center studies should be undertaken to prospectively enroll a broader spectrum of patients with different types of AF, thereby enhancing the predictive accuracy of the model.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThe structure and function of the LA and LAA are altered in patients with NVAF, with more severe functional reductions observed in those with CES. The CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc\\u0026thinsp;\\u0026ge;\\u0026thinsp;2, LASr, and LAAVImax are independent risk factors for CES in NVAF patients. LASr and LAAVImax prove to be more effective predictors of CES in NVAF patients compared to the CHA\\u003csub\\u003e2\\u003c/sub\\u003eDS\\u003csub\\u003e2\\u003c/sub\\u003e-VASc score alone. The combined index of these three parameters exhibits the highest predictive efficacy, thereby enhancing the scoring system and aiding clinicians in more accurately identifying patients at elevated risk of stroke.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study has been approved by the Ethics Committee of the First Clinical\\u003c/p\\u003e\\n\\u003cp\\u003eMedical Science College of China Three Gorges University, \\u0026amp; Yichang Central\\u003c/p\\u003e\\n\\u003cp\\u003ePeople\\u0026rsquo;s Hospital Ethics Committee, Ethics No. 2024-183-01. All subjects had\\u003c/p\\u003e\\n\\u003cp\\u003esigned informed consent forms.All research involving human subjects is in accordance with the Helsinki Declaration.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated and analyzed during the current study are not publicly\\u003c/p\\u003e\\n\\u003cp\\u003eavailable due to patient privacy and scales copyright, but are available from the\\u003c/p\\u003e\\n\\u003cp\\u003ecorresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research was supported by the Natural Science Foundation of Hubei Province (Fund No. JCZRLH202500867).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026rsquo;s\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eX.L. and S.H. wrote the main manuscript text. H.W. and X.L. calculated the data.\\u003c/p\\u003e\\n\\u003cp\\u003eD.S. and Z.A. analyzed data. Z.C. revised manuscript. All authors reviewed the\\u003c/p\\u003e\\n\\u003cp\\u003emanuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe design of the experimental choices was based on patients with non-valvular\\u003c/p\\u003e\\n\\u003cp\\u003eatrial fibrillation. We acknowledge the contribution of all patients and their\\u003c/p\\u003e\\n\\u003cp\\u003ecaregivers. Besides, ultrasound teachers also provided a lot of help and\\u003c/p\\u003e\\n\\u003cp\\u003eexpressed their thoughts and views, which were considered and included in\\u003c/p\\u003e\\n\\u003cp\\u003ethe project implementation.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no conflict of interest.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col class=\\\"decimal_type\\\"\\u003e\\n \\u003cli\\u003ePotter T B H, Tannous J, Vahidy F S. A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke[J]. Curr Atheroscler Rep, 2022,24(12):939-948.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eCollaborators G S. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021,20(10):795-820.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eMa Q, Li R, Wang L, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990\\u0026ndash;2019: an analysis for the Global Burden of Disease Study 2019[J]. Lancet Public Health, 2021,6(21):e897-e906.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eMa Yajun, Li Shujuan. Progress in diagnosis and treatment of cardioembolic stroke[J]. Chinese Journal of Arrhythmia, 2024(01):5-8.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eLiu Rixia, Liu Guangzhi. Improving the diagnosis and treatment of cardioembolic stroke: there is a long way to go[J]. Chinese Medical Journal, 2022(45):3559-3562.\\u003c/li\\u003e\\n \\u003cli\\u003eStrandberg M, Mustonen P, Taina M, et al. Etiology, diagnostics, and treatment of cardiogenic stroke[J]. Duodecim, 2016, 132(18):1625-1633.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eKatsanos A H, Kamel H, Healey J S, et al. 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Int J Cardiol, 2020,307:41-47.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eMaheshwari A, Norby F L, Inciardi R M, et al. Left Atrial Mechanical Dysfunction and the Risk for Ischemic Stroke in People Without Prevalent Atrial Fibrillation or Stroke: A Prospective Cohort Study[J]. Ann Intern Med, 2023,176(1):39-48.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eCao Xuesong, Liu Huiling, Qin Shiyang, et al. The role of transesophageal echocardiography in assessing the maximum volume, morphology, and function of the left atrial appendage in patients with cardioembolic stroke [J]. Chinese Journal of Ultrasound in Medicine, 2024,40(05):544-546.\\u003c/li\\u003e\\n \\u003cli\\u003eBieging E T, Morris A, Chang L, et al. Statistical shape analysis of the left atrial appendage predicts stroke in atrial fibrillation[J]. Int J Cardiovasc Imaging, 2021,37(8):2521-2527.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cardiovascular-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcar\",\"sideBox\":\"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcar/default.aspx\",\"title\":\"BMC Cardiovascular Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Echocardiography, transesophageal, Atrial fibrillation, Stroke, Left atrial, Left atrial appendage\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7888856/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7888856/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eAim\\u003c/strong\\u003e: Non-valvular atrial fibrillation (NVAF) serves as the primary cause of cardiogenic embolic stroke (CES), and the recurrence rate and mortality of CES are on an annual upward trend. The objective is to explore the structural and functional changes of the left atrial (LA) and left atrial appendage (LAA) in patients with NVAF by means of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in combination with two-dimensional speckle tracking imaging (2D-STI), and to identify the risk factors for CES.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e: A total of 125 patients with NVAF were recruited from our hospital, among whom 55 had CES and 70 did not. Additionally, 96 controls with sinus rhythm were included. General clinical data, as well as transthoracic and transesophageal echocardiographic data, were collected. RT-3D TEE and 2D-STI were employed to assess the structural and functional characteristics of the LA and LAA. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to evaluate the independent risk factors and their predictive value for CES.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResult\\u003c/strong\\u003e: In comparison with the control group, both NVAF groups exhibited elevated LA and LAA volumes as well as impaired functional parameters, with more pronounced alterations observed in the CES subgroup. Multivariate logistic regression analysis determined that CHA₂DS₂-VASc≥2, impaired LA reservoir strain (LASr), and an increased LAA maximum volume index (LAAVImax) were independent risk factors for CES. ROC curve analysis indicated that LAAVImax (AUC= 0.803) and LASr (AUC=0.720) had greater predictive value than CHA₂DS₂-VASc≥2 alone (AUC=0.685). The combination of all three factors resulted in the highest predictive accuracy (AUC=0.854). \\u0026nbsp;\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e: Patients with NVAF and CES demonstrate more significant dysfunction of the LA and LAA. The LASr and LAAVImax are robust predictors of CES and enhance risk stratification when integrated with clinical scores.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical trial numbe\\u003c/strong\\u003er: Not applicable.\\u003c/p\\u003e\",\"manuscriptTitle\":\"RT-3DE TEE combined with STI to evaluate the correlation between left atrial and left auricular function and stroke in patients with non-valvular atrial fibrillation: a clinical investigation\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-11-28 08:54:39\",\"doi\":\"10.21203/rs.3.rs-7888856/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-02-05T06:59:24+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-01-28T18:14:30+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"69063577243262590194493730504421350048\",\"date\":\"2026-01-14T12:35:43+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"45464731061919017795965496733185900426\",\"date\":\"2026-01-12T16:35:58+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-12T04:30:33+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-08T14:57:00+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"121182634968245883729574911794779389076\",\"date\":\"2025-11-28T12:33:15+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"271991478349325339012883676209254648542\",\"date\":\"2025-11-26T07:43:12+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-11-19T15:00:47+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-11-18T10:15:01+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-10-28T14:17:48+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-10-28T08:52:04+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Cardiovascular Disorders\",\"date\":\"2025-10-28T08:47:56+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cardiovascular-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcar\",\"sideBox\":\"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcar/default.aspx\",\"title\":\"BMC Cardiovascular Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ae687ccb-b697-4f30-b1fb-e8d411f51b47\",\"owner\":[],\"postedDate\":\"November 28th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-13T16:02:25+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7888856\",\"link\":\"https://doi.org/10.1186/s12872-026-05829-2\",\"journal\":{\"identity\":\"bmc-cardiovascular-disorders\",\"isVorOnly\":false,\"title\":\"BMC Cardiovascular Disorders\"},\"publishedOn\":\"2026-04-11 15:58:21\",\"publishedOnDateReadable\":\"April 11th, 2026\"},\"versionCreatedAt\":\"2025-11-28 08:54:39\",\"video\":\"\",\"vorDoi\":\"10.1186/s12872-026-05829-2\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12872-026-05829-2\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7888856\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7888856\",\"identity\":\"rs-7888856\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}