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Cardiac Imaging and Diagnostics · Journal article
Frontiers in Stroke · July 14, 2026
Encouraging direction, but not yet definitive.
In a single-centre retrospective cohort of 415 patients without high-risk stroke mechanisms or documented atrial fibrillation, impaired left atrial conduit strain (LAScd) was independently associated with both prevalent acute ischemic stroke at presentation and incident stroke over 3.59 years median follow-up. This suggests that echocardiographic assessment of LA function may identify cryptogenic stroke risk, but prospective validation is needed before clinical implementation.
Retrospective cross-sectional and cohort study. Patients who tested positive on FAST and did not have high-risk stroke mechanisms, presenting acutely to a single tertiary-care referral centre. Final cohort: 415 patients (251 cases with imaging-confirmed AIS, 164 controls).. Intervention: Measurement of left atrial strain (reservoir, conduit, contractile phases) by speckle-tracking echocardiography. Compared with: Patients without incident AIS during follow-up; control group without AIS at presentation. n = 415. Single tertiary-care referral centre.
LASr and LAScd were independently associated with AIS at presentation: OR per 5% increase 0.789 (95% CI 0.674–0.920) and 0.573 (95% CI 0.450–0.718), respectively During median 3.59-year follow-up, 31 patients developed incident AIS; incidence increased as LASr and LAScd tertiles worsened (P trend = 0.021 and P trend = 0.001) Only LAScd remained independently associated with incident AIS: HR per 5% increase 0.682 (95% CI 0.478–0.953)
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The finding that impaired left atrial conduit strain independently predicts both prevalent and incident stroke in patients without documented AF suggests a potential screening tool for cryptogenic stroke risk. However, this requires prospective validation and demonstration of clinical utility before adoption into routine practice.
A single-centre retrospective cohort study with modest sample size identifies an independent association between impaired left atrial strain and stroke risk in non-AF patients, but requires prospective validation before clinical application.
As stated by the source record.
Quoted from the source exactly as published.
The finding that impaired left atrial conduit strain independently predicts both prevalent and incident stroke in patients without documented AF suggests a potential screening tool for cryptogenic stroke risk. However, this requires prospective validation and demonstration of clinical utility before adoption into routine practice.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background Cryptogenic stroke, defined as a stroke with an unknown cause, poses a significant clinical challenge in cardiology and neurology. Left atrial (LA) dysfunction, as measured by left atrial strain (LAS), may identify patients who are at high risk for acute ischemic stroke (AIS), even if they do not have documented atrial fibrillation (AF). Methods This retrospective, cross-sectional and cohort study (known as the ASSISTANT Study) was conducted at a single, tertiary-care referral center. The study included patients who tested positive on the Face Arm Speech Test (FAST) and who did not have high-risk stroke mechanisms. These patients presented acutely and underwent a transthoracic echocardiogram. Speckle-tracking echocardiography was used to measure LAS in three phases: reservoir (LASr), conduit (LAScd), and contractile (LASct). The associations of LAS with imaging-confirmed acute ischemic stroke (AIS) at presentation and incident AIS during follow-up were evaluated using multivariable logistic and Cox regression analyses, respectively. Results Among the 415 patients (251 cases and 164 controls), LASr and LAScd were both independently associated with AIS at presentation [OR per 5% increase: 0.789 (95% CI, 0.674–0.920) and 0.573 (95% CI, 0.450–0.718), respectively]. During a median follow-up of 3.59 years, 31 patients developed incident AIS. The incidence of AIS increased as the tertiles of LASr ( P trend = 0.021) and LAScd ( P trend 0.001) worsened. Only LAScd remained independently associated with incident AIS [HR per 5% increase: 0.682 (95% CI, 0.478–0.953)]. Conclusion Impaired LAScd is independently associated with prevalent and incident AIS in patients without identified high-risk stroke mechanisms. Prospective studies are needed to determine whether LAScd can guide risk stratification and preventive strategies in this patient population. Trial Registration ClinicalTrials.gov (NCT07102693).
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