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Left Atrial Volumes and Function, and Long-Term Incidence of Ischemic Stroke in the General Population
Bjørn Strøier Larsen1, Flemming Javier Olsen2, Ditte Madsen Andersen2
1Department of Cardiology Copenhagen University Hospital - Bispebjerg and Frederiksberg Copenhagen Denmark.
Insights
Lower left atrial emptying fraction, a measure of heart function, is linked to a higher risk of ischemic stroke, even without atrial fibrillation. This finding highlights a potential new way to assess stroke risk.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Atrial cardiomyopathy, indicated by left atrial (LA) structural and functional changes, is a risk factor for ischemic stroke.
- Assessing LA volumes and function in the general population may identify individuals at risk for stroke, independent of atrial fibrillation or prior stroke.
Purpose of the Study:
- To investigate the association between left atrial (LA) volumes and function and the long-term risk of ischemic stroke in a general population cohort.
- To determine if LA emptying fraction and LA volumes predict future ischemic stroke events.
Main Methods:
- A community-based cohort study included 1866 participants without known atrial fibrillation or prior ischemic stroke.
- Transthoracic echocardiography was used to measure LA minimal volume, LA maximal volume, and LA emptying fraction.
- Participants were followed for a median of 16.5 years for the primary endpoint of ischemic stroke, using multivariable and competing risk models.
Main Results:
- A lower LA emptying fraction was significantly associated with an increased risk of ischemic stroke (HR, 1.14 per 10% decrease).
- This association persisted even after adjusting for the development of atrial fibrillation during follow-up.
- Indexed LA volumes were not found to be associated with ischemic stroke risk in this cohort.
Conclusions:
- Lower LA emptying fraction, assessed via echocardiography, is an independent predictor of future ischemic stroke.
- LA function, specifically emptying fraction, may be a more critical indicator of stroke risk than LA volumes in this context.
- These findings suggest LA emptying fraction could be a valuable biomarker for identifying individuals at risk for stroke.
Abstract:
Background Left atrial (LA) volumes and emptying fraction in the general population may address structural and functional aspects of atrial cardiomyopathy associated with long-term risk of ischemic stroke in the absence of atrial fibrillation or prior stroke. We investigated the association between LA volumes and function and ischemic stroke. Methods and Results In a community-based cohort, we measured LA minimal volume, LA maximal volume, and LA emptying fraction by transthoracic echocardiography. The primary end point was ischemic stroke. Participants with known atrial fibrillation or prior ischemic stroke were excluded, which resulted in 1866 participants. The mean age was 58±16 years, and 57% were women. During a median follow-up of 16.5 years (interquartile range: 11.4-16.8 years), 176 (9.4%) ischemic strokes occurred. In multivariable cause-specific regression models and competing risk models with death as a competing risk, LA emptying fraction was associated with ischemic stroke (hazard ratio [HR], 1.14 per 10% decrease [95% CI, 1.02-1.28]) and (subdistribution HR, 1.14 [95% CI, 1.01-1.29]). This association remained when adjusting for participants who developed atrial fibrillation during follow-up (HR, 1.12 per 10% decrease [95% CI, 1.00-1.26]). Indexed LA volumes were not associated with ischemic stroke in the same models. LA emptying fraction and indexed LA volumes were not associated with all-cause mortality. Conclusions Lower LA emptying fraction measured by transthoracic echocardiography was associated with future ischemic stroke independently of incident atrial fibrillation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02993172.
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