Abstract
BackgroundLeft atrial (LA) and left atrial appendage (LAA) dysfunction has been demonstrated to contribute to atrial fibrillation (AF)-related stroke. However, usefulness of LA and LAA mechanics has not been fully compared. We sought to investigate the association of LA and LAA mechanics with stroke and to compare their diagnostic values in the risk stratification of stroke in patients with nonvalvular AF.MethodsA total of 208 consecutive patients with AF (63.58 ± 10.37 years, 63.9% male,57.7% persistent AF) who underwent echocardiography before catheter ablation were prospectively enrolled. Speckle-tracking was used to measure LA and LAA global longitudinal strain (GLS). LA and LAA mechanical dispersions (MD) were defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval.ResultsPatients with prior stroke/ transient ischemic attack (TIA) (n = 31) had significantly higher LA and LAA MD than those without (n = 177) (11.56 ± 4.38% vs. 8.43 ± 3.44%, 15.15 ± 5.46% vs. 10.94 ± 4.40%, both P < 0.01). In multivariable analysis, LA and LAA MD were independently associated with stroke/TIA (odds ratio, 1.18–1.29, 1.19–1.22, respectively, both P < 0.01), providing incremental values over clinical and standard echocardiographic parameters. In a subgroup analysis, LA MD was more useful than LAA MD in patients with normal LA volumes, while LAA MD was superior to LA MD in patients with LA enlargement.ConclusionsHigher LA and LAA mechanical dispersion are independently associated with stroke/TIA in AF patients and had incremental values over clinical and conventional echocardiographic parameters. What’s more, priorities of dispersion assessment are different depending on patients’ LA size.
Highlights
Non-valvular atrial fibrillation (AF) is independently associated with 5-fold increased risk of ischaemic stroke [1]
Irregular contraction and subsequent intracardiac thrombosis has long been considered a direct mechanism for AF-related strokes [8], recent studies suggest that structural and functional abnormalities of Left atrial (LA)/left atrial appendage (LAA) may contribute to stroke/ transient ischemic attack (TIA) [9,10,11,12]
Myocardial strain analysis may measure the timing of contraction, and recent studies have demonstrated an independent association between LA and LAA mechanical dispersion (MD) and the presence of LAA thrombi or sludge [19] or stroke in AF patients [20, 21]
Summary
Non-valvular atrial fibrillation (AF) is independently associated with 5-fold increased risk of ischaemic stroke [1]. LA MD is easier to obtain and has been validated in different clinical settings to estimate subclinical LA dysfunction and can be potentially useful for predicting a variety of cardiovascular diseases, including stroke/TIA [19, 20, 22, 23]. Usefulness of both LA and LAA mechanics has not been fully compared for identification of stroke.
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