{
  "abstract": "Introduction Prolonged cardiac monitoring following stroke, has led to the identification of both more, and shorter runs of atrial fibrillation (AF). The significance of this however remains unclear, with randomised trials failing to identify a clear benefit to stroke reduction by treating this entity. This apparent paradox has led to the spotlight being focused on the very relationship between AF and stroke, and whether atrial cardiopathy actually plays a far more important role than previously considered.Purpose Functional measures of left atrial function, such as reservoir strain (LARS) ( figure 1), have consistently been shown to be an effective predictor of AF, but may even reflect a subclinical atrial cardiopathy. A variety of electrical and mechanical factors, in both the atria and the ventricles, influence LARS. Given that LARS will be affected by even small, regional left atrial changes, it is understandable why it may reflect a more sensitive marker of atrial pathology, and thus identify atrial cardiopathy. Identifying relationships between atrial cardiopathy and stroke, may help advance pathophysiological understanding, as well improve targeting of both continuous monitoring and secondary prevention strategies. The aim of this work was to systematically review published literature associating left atrial reservoir strain and the development of stroke.Abstract 6-004 Figure 1Figure 1 shows the approach to calculation of the left atrial reservoir strain in the apical 4 chamber view. The left atrium was manually contoured and split into segments, with the software creating strain curves for each segment. The QRS complex was used to determine the start point of the strain curves. The individual strain curves were averaged (dashed white line), and the 3 phases of atrial contraction (reservoir, conduit, contractile) were identified and used to measure the relevant strain values.Methods The electronic databases PubMed, Embase, Google Scholar, Scopus and Web of Science were systematically searched using the key words ‘atrial strain’ and ‘stroke’ from inception to April 2024. An initial titular analysis, followed by abstract and full text screening was performed. Data was extracted using a pre-specified collection form. A random-effects model with generic inverse variance weights was utilised to pool the most adjusted effect measure from each paper.Results After excluding duplicate studies, 2177 studies were screened, with 101 full-texts being assessed for eligibility. A total of 8 studies were identified that associated left atrial strain and subsequent stroke, and were pooled for meta-analysis.In the pooled studies a total of 17223 patients were included with 1266 cases of incident stroke. The meta-analysis of the studies suggested that a 1% reduction in left atrial strain associated with a pooled hazard ratio of 1.13 (95% CI 1.06–1.22) for incident stroke (figure 2). This implies that impaired left atrial reservoir function is associated with a higher incidence of stroke, independent of the presence of AF. Sensitivity analysis by removing one study at each time did not significantly alter the results.Abstract 6-004 Figure 2Forest plot showing the association between left atrial reservoir strain and incident stroke across the pooled studiesConclusion This comprehensive meta-analysis including 17223 patients from 8 studies, highlights the association between changes in left atrial strain and future stroke. Further work is required to explore whether this effect is mediated via a pro-thrombotic atrial cardiopathy. If so, this may have important therapeutic and monitoring implications, especially in patients who are already felt to be at increased risk of future stroke.",
  "authors": [
    {
      "affiliations": [
        "Cardiovascular Clinical Research, University of East Anglia"
      ],
      "name": "R Chattopadhyay"
    },
    {
      "affiliations": [
        "Department of Cardiology, Addenbrookes Hospital, Cambridge"
      ],
      "name": "A Elawady"
    },
    {
      "affiliations": [
        "Department of Cardiology, Addenbrookes Hospital, Cambridge"
      ],
      "name": "M Thakur"
    },
    {
      "affiliations": [
        "Cardiovascular Clinical Research, University of East Anglia"
      ],
      "name": "G Matthews"
    },
    {
      "affiliations": [
        "Department of Cardiology, Addenbrookes Hospital, Cambridge"
      ],
      "name": "P Pugh"
    },
    {
      "affiliations": [
        "Cardiovascular Clinical Research, University of East Anglia"
      ],
      "name": "V Vassiliou"
    }
  ],
  "title": "6-004 A meta-analysis on left atrial strain as a predictor of stroke",
  "uid": "22b077bf-d236-5c07-8c36-66dc258ff0e1"
}