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.