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Stroke is one of the most common causes of morbidity and mortality. The survivors of stroke have a risk of recurrence that leads to long-term disability and death. Embolism with a cardiac origin, however, is difficult to document, but accounts for approximately 20% of ischemic stroke. The emboli are most likely to originate either from atria, ventricles, or cardiac valves. The left atrial appendage (LAA) as an embryological remnant functioning as a reservoir is the prevalent site of thrombi in patients with atrial fibrillation (AF) or rheumatic mitral valve disease. The specific LAA morphology with or without organized atrial systole is independently associated with an increased risk of stroke. Beyond morphology, LAA functions, indexed by spontaneous echocardiographic contrast and the peak flow velocity, are independently associated with higher thromboembolic risk in patients with AF. Despite the well-established methodology of measuring LAA structures and functions, the assessment depends mostly on invasive transesophageal echocardiography. Complete structural and functional evaluations of the LAA are inherently prone to substantial variability during data acquisition, particularly pulsed-wave Doppler interrogation, because of anatomical challenges. The left atrium (LA) attached by LAA is easily evaluated by transthoracic echocardiography. The morphological changes of LA were a significant predictor of AF recurrence after transcatheter ablation. Regardless of the presence of AF or valvular abnormalities, LA enlargement is independently associated with cardiovascular events, particularly ischemic stroke, across various populations and genders. The LA modulates left ventricle (LV) filling by serving as a reservoir or a conduit delivering blood from pulmonary veins to LV as well as an active contractile chamber in late diastole and a suction source in early systole. Growing evidence suggests an association between LA enlargement and ventricular, arterial, and arrhythmic disorders. In addition, LA dysfunction occurs in patients with patent foramen ovale, which is associated with cryptogenic stroke. An enlarged LA may be a marker of the complexity of other cardiovascular conditions that could also increase stroke risk. Conventionally, echocardiographic assessment measuring maximum anteroposterior dimension on M-mode or 2D echocardiography in the parasternal long axis used extensively in clinical practice is an inaccurate presentation of the true LA size or volume; in particular, enlargement occurs

Left atrium phasic volume assessment: Its application in stroke patients