Differential Associations Between Left Atrial Volume Parameters and Ischemic Stroke Subtypes

Abs tractAim: An increase in left atrial diameter (LAD) is commonly used to differentiate cardioembolic stroke from other ischemic stroke subtypes.We investigated whether echocardiographic volume-indexed parameters beyond the routinely used LAD could also be used to differentiate cardioembolic from atherothrombotic ischemic stroke. Methods:In this single-center retrospective cross-sectional study, 74 patients with confirmed ischemic stroke were classified as having cardioembolic (n=33) or atherothrombotic stroke (n=41) based on neuroimaging, clinical assessment, and cardiac rhythm monitoring.Baseline demographics, National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) outcomes, and echocardiographic measurements-including left atrial diameter/height (LAD/H), left atrial diameter/body surface area (LAD/ BSA), left atrial volume index (LAVi), interventricular septal thickness, and left ventricular (LV) posterior wall thickness-were recorded.Receiver operating characteristic curve analysis was conducted to assess the discriminative performance of left atrial (LA) parameters.Results: The cardioembolic group demonstrated significantly higher NIHSS scores and worse follow-up mRS outcomes compared with the atherothrombotic group (p=0.011).Echocardiography revealed elevated values of LAD (p21.59 mm/m², and LAD/H >0.23 mm/cm.Pairwise comparisons showed no significant differences between LAD and these echocardiographic markers in discriminating cardioembolic from atherothrombotic stroke (p>0.05).Conclusion: Indexed LA measurements, particularly LAVi, LAD/H, and LAD/BSA enhance discrimination between cardioembolic and atherothrombotic stroke and may improve routine echocardiographic evaluation.