Limitations:
Our study sample was extracted from a single medical center, which may
limit the generalizability of our results. Out of 307 ESUS patients,
only 155 patients completed cardiac monitoring, and AF was detected in
32 of these patients. This small sample size may limit the significance
of our associations. For strain analysis, approximately 22% of the
total eligible patients had suboptimal images, which may lead to
potential bias in our results. This is due to the nature of our
clinical-based research, which utilized clinical echocardiographic
images instead of dedicated research echocardiograms. In addition,
several different software options are available for STE including
TomTec, which may contribute to potential variability in
echocardiographic measurements. However, our study reported comparative
measurements instead of absolute values, thus attenuating possible
variability. Finally, we did not use absolute values for abnormal LA
strain because these do not currently exist for the stroke population to
predict neurovascular clinical outcomes and is an ongoing area of
research.