Abstract
Background: Although left atrial (LA) expansion index is associated with
cardiovascular prognosis, whether it affects recurrent strokes is still
unknown. Methods: This study enrolled 176 patients hospitalized for a
first ischemic stroke. Stroke subtype was classified as cardioembolic
stroke (CE), noncardioembolic stroke (NCE), embolic stroke of
undetermined source (ESUS) or transient ischemic attack. The LA
expansion index was calculated as (Volmax-Volmin) x 100%/Volmin, where
Volmax was defined as maximal LA volume and Volmin as minimal LA volume.
The study endpoint was recurrent ischemic stroke. Results: Over a 5-year
(mean 4.9 years) follow-up period, 21 (11.9%) participants reached the
study endpoint, including 10 with CE, 5 with NCE and 6 with ESUS. The LA
expansion index was lower in the event groups compared to the non-event
group. For predicting recurrent stroke, LA expansion index <
62.5% (76% sensitivity and 68% specificity) was superior to LA volume
and E/e’. Kaplan-Meier curves revealed that the 5-year cumulative
recurrent stroke rate in patients with LA expansion index <
62.5% was 23.9%, which was significantly higher than the 5-year
cumulative recurrent stroke rate of 4.6% in patients with LA expansion
index > 62.5% (log rank p < 0.001). The LA
expansion index was a significant independent predictor of recurrent
stroke (HR 0.87; 95% CI 0.782-0.968 per 10% increase in LA expansion
index; p 0.011). Conclusion: The LA expansion index is useful for
predicting recurrent stroke.