Are left atrial abnormalities a risk for stroke?

OBJECTIVE: To show that echocardiographic left atrial enlargement (Echo-LAE) and electrocardiographic left atrial abnormalities (ECG-LAA) may be probable new risk factors for ischemic and hemorrhagic stroke.

METHODS: This descriptive prospective case study included 140 CT or MRI-confirmed hemorrhagic and ischemic stroke patients, who were admitted to Rizgary Teaching Hospital, Erbil, Iraq from January 2008 to January 2009. Twelve lead ECG and 2-dimensional transthoracic Echo were performed for all patients. Electrocardiographic LAA were identified when the P terminal force in lead V1 (PTFV1) was >40 mm.ms. Echocardiographic LAE was identified when the left atrial index was more than 2.3 cm/m2.

RESULTS: Electrocardiographic LAA were significantly higher in ischemic stroke patients in comparison with the hemorrhagic strokes. Causes of ECG-LAA were found to be as follows in order of frequency; hypertension (56%), advanced age (47%), coronary artery disease (27%), diabetes mellitus (26%), obesity (21%), valvular heart disease (21%), and 2.6% of patients had no identifiable cause. Echocardiographic-LAE was seen in 34% of ischemic strokes, and 30% of hemorrhagic strokes with no significant difference.

CONCLUSION: Although ECG-LAA (PTFV1>40 mm.ms) is significantly associated with ischemic stroke, it may not be an independent risk factor for stroke as it rarely occurred without other risk factors. Echocardiographic LAE is associated with both ischemic and hemorrhagic strokes equally.