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Left Atrial Mechanical Function and Incident Ischemic Cerebrovascular Events Independent of AF: Insights From the

Mohammadali Habibi1, Mytra Zareian2, Bharath Ambale Venkatesh3

  • 1Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

JACC. Cardiovascular Imaging
|April 22, 2019
PubMed

Insights

Reduced left atrial emptying function, measured by cardiac MRI, predicts future ischemic cerebrovascular events, including stroke and TIA, even in individuals without prior cardiovascular disease.

Area of Science:

  • Cardiovascular imaging and diagnostics
  • Neurology and cerebrovascular disease research
  • Public health and epidemiology

Background:

  • Left atrial (LA) remodeling predicts atrial fibrillation (AF), a known risk factor for ischemic cerebrovascular events (CVE).
  • The association between LA mechanical function and ischemic CVE in individuals without pre-existing cardiovascular disease remains understudied.
  • Previous research highlights LA remodeling's link to ischemic CVE, but direct assessment of LA's mechanical function is less explored.

Purpose of the Study:

  • To evaluate the relationship between baseline left atrial (LA) phasic function, assessed via cardiac magnetic resonance (CMR), and the occurrence of incident ischemic cerebrovascular events (CVE).
  • To determine if LA mechanical function provides incremental predictive value for ischemic CVE beyond established risk factors.
  • To investigate LA function in a population free of known cardiovascular disease at the study's outset.

Main Methods:

  • Utilized feature-tracking cardiac magnetic resonance (CMR) to measure phasic LA volumes, LA emptying fractions (LAEF – total, passive, active), and peak longitudinal LA strain.
  • Analyzed data from 4,261 Multi-Ethnic Study of Atherosclerosis (MESA) participants, all free of clinical cardiovascular disease at baseline.
  • Followed participants for an average of 11.6 years to identify incident ischemic CVE (ischemic stroke or transient ischemic attack).

Main Results:

  • Individuals who experienced incident ischemic CVE exhibited larger LA volumes and reduced passive, active, and total LAEF at baseline.
  • Reduced total LAEF was significantly associated with an increased risk of incident ischemic CVE after adjusting for known risk factors, left ventricular mass, and interim AF (HR: 0.85 per SD; p=0.027).
  • Incorporating total LAEF into existing risk models improved the prediction of CVE (C-statistic 0.76 vs. 0.73, p=0.039).

Conclusions:

  • Diminished total LAEF is an independent predictor of incident ischemic CVE, even when accounting for traditional risk factors and atrial fibrillation.
  • Assessing LA mechanical function using CMR can provide valuable additional information for risk stratification of asymptomatic individuals susceptible to ischemic stroke.
  • LA phasic function represents a potential novel biomarker for identifying individuals at elevated risk of cerebrovascular events.
Abstract

Keywords:
atrial fibrillationatrial functioncardiac magnetic resonanceischemic strokeleft atrial remodeling

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