Abstract
Background and Purpose: Atrial fibrillation (AF) causes remodeling of the left atrium and the left atrial appendage (LAA) that can lead to cardioembolic stroke. We investigated the association between the LAA parameters, measured using real-time three-dimensional transesophageal echocardiography (RT 3D-TEE), and the presence of AF in patients with acute ischemic stroke.Methods: We performed RT 3D-TEE for patients with acute cerebral infarction or transient ischemic attack, measuring LAA orifice area, depth, and volume offline. Patients were classified as having chronic AF (C-AF group) or paroxysmal AF (P-AF group) or not having AF (non-AF group).Results: Of 127 patients (mean age 74±11 years, 88 men), 33 were assigned to the C-AF group, 22 to the P-AF group, and 72 to the non-AF group. LAA orifice area (5.73±1.95 cm2, 4.45±2.42 cm2, and 3.23±1.47 cm2, respectively; p<0.001), eccentricity index (1.54±0.29, 1.43±0.27, and 1.37±0.13, respectively; p=0.008), depth (3.42±0.71 cm, 2.95±0.89 cm, and 2.61±0.70 cm, respectively; p<0.001), and volume (11.37±6.33 cm3, 7.59±5.03 cm3, and 4.90±2.92 cm3, respectively; p<0.001) were significantly different between groups. Post-hoc analysis revealed that only LAA orifice area and volume were useful in discriminating the three groups and that both were largest in C-AF group and smallest in non-AF group. After adjustment for sex, age, and congestive heart failure, LAA orifice area and volume were independently associated with the presence of AF.Conclusion: Paroxysmal and chronic AF may contribute to the enlargement of both LAA orifice area and volume in patients with acute ischemic stroke.
