Left Atrial Mechanical Dysfunction and the Risk for Ischemic Stroke in People Without Prevalent Atrial Fibrillation or Stroke
Year: 2022
Type: article
Study design: Observational Study
Abstract: Background: Atrial myopathy—characterized by changes in left atrial function and size—may precede and promote atrial fibrillation (AF) and cardiac thromboembolism. In people without prior AF or stroke, whether analysis of left atrial function and size can improve ischemic stroke prediction is unknown. Objective: To evaluate the association of echocardiographic left atrial function (reservoir, conduit, and contractile strain) and left atrial size (left atrial volume index) with ischemic stroke and determine whether these measures can improve the stroke prediction achieved by CHA2DS2-VASc score variables. Design: Prospective cohort study. Setting: ARIC (Atherosclerosis Risk in Communities) study. Participants: 4917 ARIC participants without prevalent stroke or AF. Measurements: Ischemic stroke events (2011 to 2019) were adjudicated by physicians. Left atrial strain was measured using speckle-tracking echocardiography. Results: Over 5 years, the cumulative incidences of ischemic stroke in the lowest quintiles of left atrial reservoir, conduit, and contractile strain were 2.99% (95% CI, 1.89% to 4.09%), 3.18% (CI, 2.14% to 4.22%), and 2.15% (CI, 1.09% to 3.21%), respectively, and that of severe left atrial enlargement was 1.99% (CI, 0.23% to 3.75%). On the basis of the Akaike information criterion, left atrial reservoir strain plus CHA2DS2-VASc variables was the best predictive model. With the addition of left atrial reservoir strain to CHA2DS2-VASc variables, 11.6% of the 112 participants with stroke after 5 years were reclassified to higher risk categories and 1.8% to lower risk categories. Among the 4805 participants who did not develop stroke, 12.2% were reclassified to lower and 12.7% to higher risk categories. Decision curve analysis showed a predicted net benefit of 1.34 per 1000 people at a 5-year risk threshold of 5%. Limitation: Underascertainment of subclinical AF. Conclusion: In people without prior AF or stroke, when added to CHA2DS2-VASc variables, left atrial reservoir strain improves stroke prediction and yields a predicted net benefit, as shown by decision curve analysis. Primary Funding Source: National Heart, Lung, and Blood Institute of the National Institutes of Health.
Source: Annals of Internal Medicine
DOI: 10.7326/m22-1638
Institutions: Pennsylvania State University, Penn State Milton S. Hershey Medical Center, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Brigham and Women's Hospital, University of Minnesota, Wake Forest University Health Sciences, Wake Forest University, Emory University, Johns Hopkins University, Johns Hopkins Medicine, National Institutes of Health, National Institute of Neurological Disorders and Stroke
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1114307781, Left Atrial Abnormality and Atrial Fibrillation-Related Cerebral Infarcts and Cognitive Decline, Significance of Atrial Fibrillation and Atrial Fibrillation Burden Detected by Novel ECG Monitoring in Community-Dwelling Elderly, Cognitive Aging, Brain Morphology, and Arrhythmias in Hispanics/Latinos: Implications for Prevention and Management of Alzheimer's Disease-Related Dementias, G3973572274, G4747441672, G4790942633, Mentoring patient-oriented research in deep phenotyping of cardiac function for heart failure prevention, G5770678025, G5928944960, G6837735701, G7155745631, G7535686976, G8738262636, Glucose patterns and cardiac arrhythmias in older adults with diabetes, Late-life trajectories of cardiac function to define pathways of cardiac resilience, Mentoring and Research to ClassifyAtrial Cardiomyopathy, Cardiovascular Disease Epidemiology & Prevention
OpenAlex ID: W4312019392