The Value of Left Atrial Longitudinal Strain In Evaluating Left Atrial Appendage Spontaneous Echo Contrast In Atrial Fibrillation patients

Background: The most prevalent persistent heart arrhythmia, atrial fibrillation (AF), is linked to a higher risk of thromboembolic stroke. The left atrial appendage spontaneous echo contrast (LAASEC) tests for thrombogenic risk and blood stasis. longitudinal strain in the left atrium (LALS) reflects atrial mechanical function and may predict LAASEC non-invasively. So, aimed to investigate relationship between LALS measured by transthoracic echocardiography and LAASEC assessed by TEE in patients with atrial fibrillation, and to evaluate the diagnostic value of LALS in detecting high-grade LAASEC. Methods: This cross-sectional observational study included 34 AF patients from Zagazig University Hospitals. Patients underwent comprehensive transthoracic echocardiography with speckle-tracking strain analysis to measure global LALS and left atrial reservoir strain (LARs). TEE was performed to assess LAASEC. Results: High LAASEC was detected in 47.1% of patients. Compared to the low LAASEC group, patients with high LAASEC were significantly older, predominantly female, and had higher CHA₂DS₂-VASc scores. All strain parameters were significantly reduced in the high LAASEC group: global LALS and LARs. ROC analysis revealed that global LALS ≤12% predicted high LAASEC with 83.33% sensitivity, 87.5% specificity, and AUC of 0.899. Multivariate analysis identified independent predictors: CHA₂DS₂-VASc score, LVEF, E/e' ratio and all three strain parameters. Conclusion: High-grade LAASEC is a reliable indicator of atrial appendage blood stasis and dramatically lowers left atrial longitudinal strain in AF patients. Transthoracic echocardiography evaluation of LALS provides a non-invasive, reproducible tool for thromboembolic risk stratification in AF patients, with potential to complement clinical scoring systems and guide anticoagulation decisions.