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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Relation of left atrial dysfunction to ischemic stroke in patients with coronary heart disease (from the heart and

Jonathan M Wong1, Christine C Welles2, Farnaz Azarbal3

  • 1Doris Duke Clinical Research Fellowship Program, University of California, San Francisco, California; Department of Medicine, California Pacific Medical Center, San Francisco, California.

The American Journal of Cardiology
|May 6, 2014
PubMed

Insights

Left atrial dysfunction, measured by the left atrial function index (LAFI), independently predicts ischemic stroke risk. Reduced LAFI significantly increases the likelihood of stroke or transient ischemic attack (TIA), even without atrial fibrillation.

Area of Science:

  • Cardiology
  • Neurology
  • Diagnostic Imaging

Background:

  • Atrial fibrillation (AF) is a known risk factor for ischemic stroke due to impaired left atrial (LA) function.
  • Ischemic stroke also occurs in patients without diagnosed AF, suggesting other factors contributing to stroke risk.
  • The independent predictive value of LA dysfunction on ischemic stroke risk remains unclear.

Purpose of the Study:

  • To investigate whether left atrial (LA) dysfunction is an independent predictor of ischemic stroke or transient ischemic attack (TIA).
  • To quantify LA dysfunction using the left atrial function index (LAFI) derived from echocardiography.
  • To assess the association between LAFI and the incidence of ischemic stroke/TIA in patients with stable coronary heart disease.

Main Methods:

  • Transthoracic echocardiography was performed on 983 subjects with stable coronary heart disease.
  • Left atrial function index (LAFI) was calculated using LA volumes at end-atrial systole and diastole.
  • Cox proportional hazards models analyzed the relationship between LAFI and ischemic stroke/TIA over a mean follow-up of 7.1 years.

Main Results:

  • A total of 58 participants (5.9%) experienced an ischemic stroke or TIA.
  • In patients without baseline AF or warfarin therapy (n=893), the lowest quintile of LAFI showed a >3-fold increased risk of stroke/TIA (HR 3.3, p=0.03).
  • A decrease in LAFI by one standard deviation was associated with a 50% increased hazard of stroke/TIA (HR 1.5, p=0.04), and LAFI was the strongest echocardiographic predictor.

Conclusions:

  • Left atrial dysfunction, quantified by LAFI, is an independent risk factor for ischemic stroke and TIA.
  • LA dysfunction predicts stroke risk even in patients without a history of atrial fibrillation.
  • Echocardiographic assessment of LA function, particularly LAFI, can identify individuals at elevated risk for cerebrovascular events.

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