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Updated: Jun 6, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Subtle signs of atrial cardiomyopathy and left ventricular diastolic dysfunction are associated with reduced
Amelie H Ohlrogge1,2, Stephan Camen1,2, Lina Nagel3
1Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Insights
Subclinical atrial cardiomyopathy, indicated by echocardiography, is linked to poorer cognitive function in the general population. This highlights the crucial connection between heart health and brain function, known as the cardio-cerebral axis.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Atrial fibrillation is a known risk factor for cognitive dysfunction.
- Atrial cardiomyopathy has been correlated with both atrial fibrillation and cognitive impairment.
- Understanding the link between atrial cardiomyopathy and cognitive changes is crucial for public health.
Purpose of the Study:
- To investigate the association between echocardiographic markers of atrial cardiomyopathy and cognitive function.
- To explore the relationship between atrial cardiomyopathy and cerebral changes, such as white matter hyperintensities.
- To characterize the cardio-cerebral axis in a population-based study.
Main Methods:
- Utilized data from the population-based Hamburg City Health Study.
- Conducted in-depth transthoracic echocardiography and comprehensive cognitive function testing.
- Included cerebral magnetic resonance imaging to assess brain structure.
Main Results:
- The E/e'-ratio, a marker of diastolic dysfunction, was associated with impaired performance on the Animal Naming Test (ANT) and Trail Making Test A (TMT-A).
- Left atrial global peak strain correlated with better performance on TMT-A, TMT-B, and 10-word learning test recall.
- The E/e'-ratio showed a trend towards association with white matter hyperintensity load, though not statistically significant after multivariable adjustment.
Conclusions:
- Subclinical echocardiographic signs of atrial cardiomyopathy and left ventricular diastolic dysfunction are linked to cognitive deficits.
- The findings support the existence of a clinically significant cardio-cerebral axis.
- Cardiac dysfunction, even when subclinical, may impact cognitive performance.
Background:
Atrial fibrillation is associated with cognitive dysfunction. Atrial cardiomyopathy has been correlated with both entities. We aimed to characterize the association of echocardiographic parameters of atrial cardiomyopathy with cognitive function and cerebral changes.
Methods:
Participants of the population-based Hamburg City Health Study underwent in-depth transthoracic echocardiography and cognitive function testing, the Animal Naming Test (ANT), the Trail Making Test A (TMT-A) and B (TMT-B), 10-word learning test and cerebral magnetic resonance imaging.
Results:
After excluding individuals with stroke or depression, data from 7852 individuals were available. In multi-variable-adjusted regression analyses, the E/e'-ratio was associated with the level of impairment in the ANT (- 0.19 per one standard deviation [SD] increase, 95% confidence interval [CI] - 0.36-[- 0.01]) and the TMT-A (0.01 per one SD increase, 95% CI 0.003-0.020). Left atrial global peak strain was associated with positive performance in the TMT-A and B (-0.01 per one SD increase [95% CI - 0.02-(- 0.002)] and - 0.02 per one SD increase [95% CI - 0.03-(- 0.01)], respectively) and the immediate recall of the 10-word learning test (0.11 per one SD increase, 95% CI 0.02-0.20). The E/e'-ratio was positively associated with the total and periventricular white matter hyperintensity load in age- and sex-adjusted regression analyses though statistical significance was lost after multi-variable adjustment.
Conclusions:
Subclinical echocardiographic signs of atrial cardiomyopathy and left ventricular diastolic dysfunction are associated with impaired performance in cognitive tests in the population. Our data provide evidence of the clinically important cardio-cerebral axis, relating cardiac dysfunction with cognitive performance.
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