Isil Yazici Gencdal, Ersan Oflar, Atilla Koyuncu, Kursad Nuri Baydili, Dilek Atakli, Aysu Sen, Aysun Soysal
The Medical Bulletin of Haseki - 2026;64(1):50-56
Aim: An increase in left atrial diameter (LAD) is commonly used to differentiate cardioembolic stroke from other ischemic stroke subtypes. We investigated whether echocardiographic volume-indexed parameters beyond the routinely used LAD could also be used to differentiate cardioembolic from atherothrombotic ischemic stroke. Methods: In this single-center retrospective cross-sectional study, 74 patients with confirmed ischemic stroke were classified as having cardioembolic (n=33) or atherothrombotic stroke (n=41) based on neuroimaging, clinical assessment, and cardiac rhythm monitoring. Baseline demographics, National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) outcomes, and echocardiographic measurements-including left atrial diameter/height (LAD/H), left atrial diameter/body surface area (LAD/BSA), left atrial volume index (LAVi), interventricular septal thickness, and left ventricular (LV) posterior wall thickness-were recorded. Receiver operating characteristic curve analysis was conducted to assess the discriminative performance of left atrial (LA) parameters. Results: The cardioembolic group demonstrated significantly higher NIHSS scores and worse follow-up mRS outcomes compared with the atherothrombotic group (p=0.011). Echocardiography revealed elevated values of LAD (p<0.001), LAD/H (p<0.001), LAD/BSA (p=0.004), and LAVi (p=0.004) in patients with cardioembolic stroke, while interventricular septum and LV posterior wall thicknesses showed no significant intergroup differences. Receiver operating characteristic analysis identified LAVi, LAD/H, LAD/BSA, and LAD as significant discriminators. Optimal thresholds included LAVi >42 mL/m², LAD/BSA >21.59 mm/m², and LAD/H >0.23 mm/cm. Pairwise comparisons showed no significant differences between LAD and these echocardiographic markers in discriminating cardioembolic from atherothrombotic stroke (p>0.05). Conclusion: Indexed LA measurements, particularly LAVi, LAD/H, and LAD/BSA enhance discrimination between cardioembolic and atherothrombotic stroke and may improve routine echocardiographic evaluation.
