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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm

Jae-Hyeong Park1, In-Chang Hwang2, Jin Joo Park2

  • 1Department of Cardiology in Internal Medicine Chungnam National University HospitalChungnam National University College of Medicine Daejeon Korea.

Journal of the American Heart Association
|June 30, 2021
PubMed

Insights

Reduced left atrial global longitudinal strain (LAGLS) in heart failure (HF) patients predicts stroke risk. A LAGLS below 14.5% approximately doubles stroke risk in acute HF patients with sinus rhythm.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Diagnostics

Background:

  • Stroke is a significant comorbidity in heart failure (HF) patients, particularly those with impaired left atrial (LA) function.
  • Identifying high-risk individuals is crucial for stroke prevention in acute HF.
  • Left atrial global longitudinal strain (LAGLS) may serve as a predictive marker.

Purpose of the Study:

  • To evaluate the predictive value of LAGLS for new-onset stroke in patients with acute HF and sinus rhythm.
  • To identify specific LAGLS thresholds associated with increased stroke risk.

Main Methods:

  • Retrospective analysis of 2461 acute HF patients with sinus rhythm from three tertiary hospitals.
  • HF phenotypes classified based on left ventricular ejection fraction (EF): reduced (≤40%), midrange (40%-<50%), and preserved (≥50%).
  • LAGLS measured, and patients followed for new-onset stroke over a mean of 30.3 months.

Main Results:

  • 100 patients experienced stroke during follow-up.
  • Patients with stroke exhibited higher LA diameter and lower LAGLS compared to those without.
  • Multivariate analysis revealed each 1% decrease in LAGLS increased stroke risk by 3.8% (HR 1.038).
  • A LAGLS cutoff of 14.5% was associated with approximately double the stroke risk (HR 1.940) after adjusting for other variables.

Conclusions:

  • Decreased LAGLS (<14.5%) is a significant independent predictor of increased stroke risk in acute HF patients with sinus rhythm.
  • The annual stroke incidence in this high-risk group (LAGLS <14.5%) was 2.38%.
  • LAGLS measurement offers valuable prognostic information for stroke risk stratification in HF.

Keywords:
heart failurestrain echocardiographystroke

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