Heart and Vessels

, Volume 34, Issue 12, pp 1936–1943 | Cite as

Left atrial remodeling index is a feasible predictor of poor prognosis in patients with acute ischemic stroke

  • Naoto Hashimoto
  • Tetsu WatanabeEmail author
  • Harutoshi Tamura
  • Hayato Tsuchiya
  • Masahiro Wanezaki
  • Shigehiko Kato
  • Satoshi Nishiyama
  • Takanori Arimoto
  • Hiroki Takahashi
  • Tetsuro Shishido
  • Masafumi Watanabe
Original Article


Left atrial (LA) functional remodeling as well as LA structural remodeling are associated with incident LA appendage (LAA) thrombus formation. This study aimed to elucidate whether combined assessment of LA functional and structural remodeling can predict LAA dysfunction and recurrent cerebrovascular events in patients with acute ischemic stroke. We performed transthoracic and transesophageal echocardiography in 196 patients within 7 days after acute ischemic stroke. Peak systolic LA strain was evaluated using 2D speckle tracking imaging. We defined the ratio of LA peak systolic strain to LA volume index (LAVI) as the LA remodeling index (LARI). All patients were prospectively followed for recurrent cerebrovascular events. We divided patients into four groups according based on the LARI quartile. LAA dysfunction increased with decreasing LARI. In total, 52 recurrent cerebrovascular events were noted during the median follow-up period of 700 days. Patients with recurrent cerebrovascular events had lower LARI than those without recurrent events (0.50 ± 0.45 vs. 1.10 ± 0.95, P < 0.001). Kaplan–Meier analysis showed that patients with lower LARI were more susceptible to recurrent cerebrovascular events than those with higher LARI. Multivariate Cox proportional hazard regression analysis showed that LARI was an independent predictor of recurrent cerebrovascular events after adjustment for confounding factors. Net reclassification index improved with the addition of LARI to basic predictors. LARI is a novel feasible parameter for LAA dysfunction and can predict recurrent cerebrovascular events in patients with acute ischemic stroke.


Left atrial remodeling Left atrial strain 2D speckle tracking Ischemic stroke Transthoracic echocardiography 



We would like to thank the staff at the Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine for their cooperation during this study. We would like to thank Editage ( for English language editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Naoto Hashimoto
    • 1
  • Tetsu Watanabe
    • 1
    Email author
  • Harutoshi Tamura
    • 1
  • Hayato Tsuchiya
    • 1
  • Masahiro Wanezaki
    • 1
  • Shigehiko Kato
    • 1
  • Satoshi Nishiyama
    • 1
  • Takanori Arimoto
    • 1
  • Hiroki Takahashi
    • 1
  • Tetsuro Shishido
    • 1
  • Masafumi Watanabe
    • 1
  1. 1.Department of Cardiology, Pulmonology, and NephrologyYamagata University School of MedicineYamagataJapan

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