Atrial Cardiopathy in Young Adults With Embolic Stroke of Undetermined Source: A Myocardial Deformation Imaging Analysis

Background: Atrial cardiopathy (AC) has emerged as a potential pathological thrombogenic atrial substract of embolic stroke of undetermined source (ESUS), even in the absence of atrial fibrillation. Left atrium (LA) myocardial deformation analysis may be of value as a subclinical marker of AC and a predictor of ESUS. Aims: To compare LA mechanical function between ESUS cases and age and sex-matched controls. Methods: A single-center analytical study with case-control design was performed. The case group was composed of young patients admitted to the Neurology department from January 2017 to June 2021. The control group was composed of age and sex-matched controls recruited from the community. All participants performed echocardiograms and a smaller sample underwent cardiac magnetic resonance. Results: We recruited 31 ESUS patients aged between 18 and 65 years and 31 age and sex-matched controls. ESUS patients had a significantly higher prevalence of cardiovascular risk factors and patent foramen ovale (PFO). The prevalence of AC was not different between groups. Echocardiogram parameters, including strain analysis, were similar between groups, except for LA appendage (LAA) ostium variation which was significantly lower in ESUS patients (absolute: 6.5vs8.7mm, p<0.001; relative: 44.5%vs53.4%, p=0.002). After the exclusion of patients with PFO, all the results were statistically similar. Regarding cardiac magnetic resonance analysis, there were no statistically significant differences between groups. Conclusion: This study shows that in our population AC and atrial function was not associated with ESUS. LAA structural and functional abnormalities may play a major role. The role of LAA in ESUS warrants further studies.