Abstract Details

Title Unmasking Atrial Cardiopathy: A Systematic Review and Meta-analysis of Left Atrial Strain Implicated in Embolic Stroke of Undetermined Source

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-022

Objective To systematically evaluate left atrial (LA) strain parameters in patients with embolic stroke of undetermined source (ESUS) compared with other ischemic stroke subtypes, and to determine whether impaired atrial mechanical function supports atrial cardiopathy as an atrial fibrillation–independent mechanism of embolic stroke.

Background Embolic stroke of undetermined source (ESUS) accounts for up to one-third of ischemic strokes, yet optimal secondary prevention remains uncertain due to heterogeneous underlying mechanisms. Atrial cardiopathy has emerged as a potential driver of embolic risk even in the absence of atrial fibrillation (AF). Left atrial (LA) strain, assessed by speckle-tracking echocardiography, is a novel noninvasive biomarker of atrial dysfunction that may improve risk stratification.

Design/Methods We systematically searched PubMed, Embase, Scopus, and Cochrane through July 2025 for studies evaluating LA strain in ESUS. Eligible studies compared LA strain metrics in ESUS versus other ischemic stroke subtypes. Data extracted included study design, patient characteristics, and quantitative LA strain measures: reservoir (LASr), conduit (LAScd), and contractile (LASct). Pooled mean differences (MDs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Heterogeneity was assessed.

Results
Four studies (n = 834; ESUS = 413) met the inclusion criteria. Compared with non-cardioembolic ischemic stroke, ESUS was associated with significantly impaired LASr (MD −5.92%, 95% CI −8.82 to −3.02) and LAScd (MD −3.42%, 95% CI −6.21 to −0.64), with a trend toward lower LASct (MD −1.59%, 95% CI −3.62 to 0.45). Across cohorts, LASr and LAScd also differentiated ESUS from large-vessel occlusion stroke.

Conclusions
This first meta-analysis focused on LA strain in ESUS demonstrates significant impairment of atrial mechanical function, particularly reservoir strain, reinforcing atrial cardiopathy as an AF-independent mechanism of embolic stroke. LA strain shows promise as a biomarker to refine risk stratification and guide future secondary prevention trials in ESUS.

Authors/Disclosures
Sangharsha Thapa, MD PRESENTER	Dr. Thapa has nothing to disclose.
Sangam Shah (Tribhuvan University, Institute of Medicine)	Dr. Shah has nothing to disclose.
Amaara Wahid	Ms. Wahid has nothing to disclose.
Mustafa I. Ahmed, MD	Dr. Ahmed has nothing to disclose.
Chaitanya Medicherla, MD	Dr. Medicherla has nothing to disclose.
Tomoko Kitago, MD (Westchester Medical Center)	Dr. Kitago has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for MindMaze. The institution of Dr. Kitago has received research support from American Speech-Language Hearing Foundation. The institution of Dr. Kitago has received research support from National Institutes of Health.

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