Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS

Francesco Bianco, Raffaele De Caterina, Alvin Chandra, Iolanda Aquila, Brian Claggett, Michelle C. Johansen, Alexandra Gonçalves, Faye L. Norby, Rebecca Cogswell, Elsayed Z. Soliman, Rebecca Gottesman, Thomas Mosley, Alvaro Alonso, Amil Shah, Scott D. Solomon, Lin Yee Chen

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Age-related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3-dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. METHODS AND RESULTS: We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3-dimensional echocardio-graphic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging– detectable infarcts (n=315), magnetic resonance imaging– diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain—a 3-dimensional echocardiographic index of LA reservoir function—and E/e’ divided by LA global longitudinal strain—an index of LA stiffness—worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e’ divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. CONCLUSIONS: In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age-related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke.

Original languageEnglish (US)
Article numbere024292
JournalJournal of the American Heart Association
Volume11
Issue number9
DOIs
StatePublished - May 3 2022
Externally publishedYes

Keywords

  • 3-dimensional echocardiography
  • left atrial function
  • left atrial stiffness
  • left atrial strain
  • subclinical cerebral infarctions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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