Left atrial reservoir strain and contractile strain were independently associated with later-detected atrial fibrillation after acute ischemic stroke and 'may help identify patients who may warrant closer rhythm surveillance when extended monitoring is limited.'
Key Findings
Results
Later-detected atrial fibrillation occurred in 4.7% of acute ischemic stroke patients without prior or concurrent AF over a median follow-up of approximately 30 months.
Study included 490 patients with acute ischemic stroke (AIS) without prior or concurrent AF who underwent speckle-tracking left atrial strain (LAS) analysis.
Later-detected AF was defined as AF newly documented more than 7 days after the index stroke.
23 patients (4.7%) developed later-detected AF.
Median follow-up was 30.6 months.
Results
Patients with later-detected AF had significantly lower LA reservoir strain (LASr) compared to those without AF.
LASr was 22.4% ± 5.3% in patients with later-detected AF versus 29.1% ± 8.9% in those without AF.
Difference was statistically significant (p < 0.001).
LASr was measured using speckle-tracking echocardiography during routine echocardiography.
This is a retrospective study design.
Results
Patients with later-detected AF had significantly less negative LA contractile strain (LASct) compared to those without AF.
LASct was -11.3% ± 4.2% in patients with later-detected AF versus -16.3% ± 5.5% in those without AF.
Difference was statistically significant (p < 0.001).
LASct reflects the contractile phase of left atrial function.
Results
Both LASr and LASct remained independently associated with later-detected AF after multivariable adjustment for CHA2DS2-VA score and LA volume index.
LASr: odds ratio (OR) 0.93; 95% confidence interval (CI) 0.87–0.98; p = 0.010.
LASct: OR 0.86; 95% CI 0.78–0.93; p < 0.001.
Models were adjusted for CHA2DS2-VA score and LA volume index (LAVI).
Lower (worse) strain values were associated with higher odds of later-detected AF.
Results
ROC analysis demonstrated modest discriminatory ability for LASr, LASct, and LAVI in identifying patients with later-detected AF.
Exploratory receiver operating characteristic (ROC) analysis was performed for LASr, LASct, and LAVI.
The discriminatory ability was described as 'modest' for all three parameters.
Specific AUC values were not reported in the abstract.
Results suggest these measures have some but limited standalone diagnostic utility.
What This Means
This research suggests that measurements of how well the left atrium (the upper-left chamber of the heart) stretches and contracts, obtained through a type of ultrasound called speckle-tracking echocardiography, can help predict which stroke patients are more likely to later develop an irregular heart rhythm called atrial fibrillation (AF). The study followed 490 stroke patients who did not have AF at the time of their stroke, and found that about 1 in 20 (4.7%) went on to develop AF over roughly two and a half years. Those who later developed AF showed noticeably worse left atrial function on their initial echocardiogram, as reflected by lower reservoir strain and less contractile strain values.
Importantly, these associations held even after accounting for other known risk factors such as the CHA2DS2-VA clinical risk score and the size of the left atrium. This means that left atrial strain measurements provide additional information beyond what clinicians already use. However, the ability of these measurements alone to accurately distinguish who will and won't develop AF was only 'modest,' meaning they are not definitive tests on their own.
This research matters because detecting AF after a stroke is clinically important — AF significantly increases the risk of future strokes, and identifying it can lead to treatments like blood thinners that reduce that risk. Extended heart rhythm monitoring is not always available or practical for all patients. This study suggests that left atrial strain measurements, which can be obtained during standard echocardiography already performed in many stroke patients, could help identify those who most need closer or longer-term heart rhythm monitoring.
Choi H, Chu H, Seo W, Kim S, Lee J, Park D, et al.. (2026). Left Atrial Strain for Risk Stratification of Later-Detected Atrial Fibrillation After Acute Ischemic Stroke.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70628