{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:10:33Z","timestamp":1790154633612,"version":"4.0.1"},"reference-count":28,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Embolic Stroke of Undetermined Source (ESUS) refers to non-lacunar ischemic stroke without an identified cause and is presumed to be related to a cardioembolic mechanism. A potential etiological factor is atrial fibrosis leading to left atrial (LA) dysfunction, also known as atrial cardiomyopathy. This study aimed to compare advanced transthoracic echocardiographic parameters of LA function in patients with ESUS and age- and sex-matched controls. Methods: In this prospective matched observational case\u2013control study, fifty patients with ESUS and 50 age- and sex-matched controls were analyzed. All participants underwent comprehensive transthoracic echocardiography (TTE). LA parameters included four-dimensional volumetry, LA strain (LAS), and LA stiffness index calculated as the ratio of E\/e\u02b9 to reservoir strain. All ESUS patients additionally underwent transesophageal echocardiography (TEE) to assess the presence of patent foramen ovale (PFO). Results: Compared with controls, ESUS patients had significantly reduced LAS in the reservoir phase (LAS-r 37.3% vs. 42.3%; p &lt; 0.01) and conduit phase (LAS-cd 22.9% vs. 28.4%; p &lt; 0.01), as well as a higher LA stiffness index (0.171 vs. 0.149; p &lt; 0.01). No significant differences were found in LA size or volume. In subgroup analysis, ESUS patients with and without PFO did not differ, while both subgroups showed significant impairment compared with controls. Conclusions: ESUS is associated with impaired LA functional properties despite preserved LA size. LAS may provide complementary information on subclinical LA functional abnormalities in patients with ESUS; however, its clinical and prognostic significance requires validation in prospective studies.<\/jats:p>","DOI":"10.3390\/jcm15197378","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:14:39Z","timestamp":1790151279000},"page":"7378","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impaired Left Atrial Function in Patients with Embolic Stroke of Undetermined Source"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2283-3356","authenticated-orcid":false,"given":"Urszula","family":"Gancarczyk","sequence":"first","affiliation":[{"name":"Department of Transplantology and Mechanical Circulatory Support, Krakow Specialist Hospital Named After St. John Paul II, ul. Pr\u0105dnicka 80, 31-202 Krak\u00f3w, Poland"},{"name":"Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, ul. \u015aw. \u0141azarza 16, 31-530 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3073-2865","authenticated-orcid":false,"given":"Andrea","family":"Stefanini","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6957-3590","authenticated-orcid":false,"given":"Pawe\u0142","family":"Prochownik","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, ul. Pr\u0105dnicka 80, 31-202 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Marcin","family":"Jakiel","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, ul. Pr\u0105dnicka 80, 31-202 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4474-1006","authenticated-orcid":false,"given":"Micha\u0142","family":"Tworek","sequence":"additional","affiliation":[{"name":"Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, ul. \u015aw. \u0141azarza 16, 31-530 Krak\u00f3w, Poland"},{"name":"Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, ul. Pr\u0105dnicka 80, 31-202 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2299-8206","authenticated-orcid":false,"given":"Wojciech","family":"P\u0142azak","sequence":"additional","affiliation":[{"name":"Department of Transplantology and Mechanical Circulatory Support, Krakow Specialist Hospital Named After St. John Paul II, ul. Pr\u0105dnicka 80, 31-202 Krak\u00f3w, Poland"},{"name":"Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, ul. Pr\u0105dnicka 80, 31-202 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3872-8964","authenticated-orcid":false,"given":"Matteo","family":"Cameli","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Monika","family":"Komar","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, ul. Pr\u0105dnicka 80, 31-202 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S1474-4422(13)70310-7","article-title":"Embolic strokes of undetermined source: The case for a new clinical construct","volume":"13","author":"Hart","year":"2014","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1093\/eurheartj\/ehae150","article-title":"Embolic strokes of undetermined source: A clinical consensus statement of the ESC Council on Stroke, the European Association of Cardiovascular Imaging and the European Heart Rhythm Association of the ESC","volume":"45","author":"Ntaios","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jacc.2019.11.024","article-title":"Embolic stroke of undetermined source: JACC review topic of the week","volume":"75","author":"Ntaios","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2015.09.011","article-title":"Guidelines for the use of echocardiography in the evaluation of a cardiac source of embolism","volume":"29","author":"Saric","year":"2016","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1161\/01.STR.22.6.727","article-title":"Transesophageal echocardiography in the detection of potential cardiac source of embolism in stroke patients","volume":"22","author":"Cujec","year":"1991","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"euae204","DOI":"10.1093\/europace\/euae204","article-title":"Atrial cardiomyopathy revisited\u2014Evolution of a concept: A clinical consensus statement of the European Heart Rhythm Association (EHRA), Heart Rhythm Society (HRS), Asian Pacific Heart Rhythm Society (APHRS), and Latin American Heart Rhythm Society (LAHRS)","volume":"26","author":"Goette","year":"2024","journal-title":"Europace"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.jacc.2013.10.055","article-title":"Left atrial size and function: Role in prognosis","volume":"63","author":"Hoit","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mangia, M., D\u2019andrea, E., Cecchetto, A., Beccari, R., Mele, D., and Nistri, S. (2024). Current and clinically relevant echocardiographic parameters to analyze left atrial function. J. Cardiovasc. Dev. Dis., 11.","DOI":"10.3390\/jcdd11080241"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1093\/ehjci\/jeaf014","article-title":"The role of multimodality imaging for the assessment of left atrium and left atrial appendage: A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA)","volume":"26","author":"Sade","year":"2025","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.acvd.2024.06.002","article-title":"Scientific statement from the French neurovascular and cardiac societies for improved detection of atrial fibrillation after ischemic stroke and transient ischemic attack","volume":"117","author":"Gaillard","year":"2024","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Dini, F.L., Cameli, M., Stefanini, A., Aboumarie, H.S., Lisi, M., Lindqvist, P., and Henein, M.Y. (2024). Echocardiography in the assessment of heart failure patients. Diagnostics, 14.","DOI":"10.3390\/diagnostics14232730"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"29","author":"Nagueh","year":"2016","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: Recommendations from the American Society of Echocardiography","volume":"32","author":"Mitchell","year":"2019","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.jcmg.2024.07.011","article-title":"Myocardial strain imaging: Theory, current practice, and the future","volume":"18","author":"Smiseth","year":"2025","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1007\/s10554-021-02499-3","article-title":"Comparison of left atrial strain by feature-tracking cardiac magnetic resonance with speckle-tracking transthoracic echocardiography","volume":"38","author":"Benjamin","year":"2022","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_18","first-page":"e016197","article-title":"Left atrial strain predicts subclinical atrial fibrillation detected by long-term continuous monitoring in elderly high-risk individuals","volume":"17","author":"Olsen","year":"2024","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e002763","DOI":"10.1161\/CIRCHEARTFAILURE.115.002763","article-title":"Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction","volume":"9","author":"Santos","year":"2016","journal-title":"Circ. Heart Fail."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/j.jcmg.2023.01.015","article-title":"Prognostic utility of left atrial strain to predict thrombotic events and mortality in amyloid cardiomyopathy","volume":"16","author":"Akintoye","year":"2023","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.echo.2021.12.010","article-title":"Left atrial deformation imaging and atrial fibrillation in patients with rheumatic mitral stenosis","volume":"35","author":"Stassen","year":"2022","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_22","first-page":"i245","article-title":"Left atrial strain and risk of systemic embolic events in rheumatic mitral stenosis in sinus rhythm","volume":"25","author":"Lee","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e15738","DOI":"10.1111\/echo.15738","article-title":"Left atrial strain, embolic stroke of undetermined source, and atrial fibrillation detection","volume":"41","author":"Bashir","year":"2024","journal-title":"Echocardiography"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1093\/ehjci\/jeaa287","article-title":"Usefulness of left atrial strain for predicting incident atrial fibrillation and ischemic stroke in the general population","volume":"23","author":"Alhakak","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e14175","DOI":"10.1111\/eci.14175","article-title":"Altered left atrial metrics in patients with cryptogenic stroke: A systematic review and meta-analysis","volume":"54","author":"Clark","year":"2024","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/ehjci\/jeaa311","article-title":"Left atrial mechanics for secondary prevention from embolic stroke of undetermined source","volume":"23","author":"Sade","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e70093","DOI":"10.1111\/anec.70093","article-title":"The role of left atrial strain in differentiating embolic stroke of undetermined source from other acute ischemic stroke subtypes related to large-vessel occlusion","volume":"30","author":"Zhang","year":"2025","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Gazagnes, J., Gollion, C., Fournier, P., Cariou, E., Larrue, V., and Lairez, O. (2020). Left atrial function in young patients with cryptogenic stroke and patent foramen ovale: A left atrial longitudinal strain study. Front. 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