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Association of Atrial Fibrillation With Stroke and Dementia Accounting for Left Atrial Function and Size

Michael J Zhang1,2, Yuekai Ji3, Wendy Wang3

  • 1Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.

JACC. Advances
|November 13, 2023
PubMed

Insights

Atrial fibrillation (AF) is linked to stroke and dementia, but this risk may be explained by atrial myopathy. Adjusting for left atrial function and size eliminated the significant association between AF and these conditions.

Area of Science:

  • Cardiology
  • Neurology
  • Geriatrics

Background:

  • Atrial fibrillation (AF) is a known risk factor for ischemic stroke (IS) and dementia.
  • The role of atrial myopathy (alterations in left atrial function/size) in confounding these associations is unclear.

Purpose of the Study:

  • To investigate the association between prevalent and incident AF with IS and dementia.
  • To determine if left atrial (LA) function and size mediate or confound these risks.

Main Methods:

  • Analysis of echocardiographic data on LA function and size in the ARIC study cohort.
  • Time-varying Cox regression was used to analyze associations between AF, IS, and dementia over a median follow-up of 7.1 years.

Main Results:

  • Initially, AF was significantly associated with increased risk of IS and dementia.
  • After adjusting for LA reservoir strain, LA contractile strain, LA emptying fraction, and LA minimal volume index, these associations were attenuated and no longer statistically significant.

Conclusions:

  • The observed associations between AF, IS, and dementia were not statistically significant after accounting for measures of atrial myopathy.
  • This study suggests that atrial myopathy may confound the relationship, challenging AF's role as an independent risk factor for IS and dementia.
Abstract

Keywords:
atrial myopathyleft atriumreservoir strainspeckle tracking

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