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CMR-Derived Atrial Strain in the Prediction of Adverse Cerebrovascular Events After Myocardial Infarction

Riccardo Cau1, Carlotta Onnis2, Gianluca Pontone3

  • 1Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Italy; University of Cagliari, Cagliari, Italy.

The American Journal of Cardiology
|September 24, 2025
PubMed

Insights

Cardiovascular magnetic resonance (CMR) can assess atrial strain in ST-segment elevation myocardial infarction (STEMI) patients. Lower left atrial (LA) reservoir and conduit strain predict cerebrovascular events, aiding risk stratification.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Neurology

Background:

  • ST-segment elevation myocardial infarction (STEMI) patients face risks of cerebrovascular events.
  • Atrial function, assessed via strain parameters, may influence stroke risk.
  • Cardiovascular magnetic resonance (CMR) offers detailed cardiac imaging.

Purpose of the Study:

  • To investigate the association between CMR-derived atrial strain parameters and new-onset cerebrovascular events in STEMI patients.
  • To determine if left atrial (LA) reservoir, conduit, and booster strain predict cerebrovascular events post-STEMI.
  • To evaluate the utility of atrial strain in risk stratification for STEMI survivors.

Main Methods:

  • Retrospective analysis of 211 STEMI patients who underwent coronary revascularization.
  • CMR scans assessed for left atrial (LA) reservoir, conduit, and booster strain using cine steady-state free precession sequences.
  • Follow-up for cerebrovascular events (acute ischemic stroke or transient ischemic attack) analyzed using multivariable Cox regression.

Main Results:

  • 23 patients (11%) experienced cerebrovascular events during a median 25-month follow-up.
  • LA reservoir strain (HR: 0.84; p=0.001) and LA conduit strain (HR: 0.74; p=0.001) were independent predictors of cerebrovascular events.
  • These associations remained significant after adjusting for cardiovascular risk factors, LA volume, thrombus, and atrial fibrillation.

Conclusions:

  • CMR-derived LA reservoir and conduit strain are independently associated with an increased risk of cerebrovascular events in STEMI patients.
  • These atrial strain parameters may serve as novel biomarkers for stroke risk.
  • Integrating LA strain analysis into clinical assessment could enhance risk stratification for STEMI patients.

Keywords:
atriummyocardial infarction: cmrstroke

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