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

• Authors: Francesco Bianco, Brigham and Women's Hospital, Boston; Raffaele De Caterina, University of Pisa; Alvin Chandra, Brigham and Women's Hospital, Boston; Iolanda Aquila, Brigham and Women's Hospital, Boston; Brian Claggett, Brigham and Women's Hospital, Boston; Michelle C Johansen, Johns Hopkins University; Alexandra Goncalves, Brigham and Women's Hospital, Boston; Faye L Norby, Cedars‐Sinai Smidt Heart Institute; Rebecca Cogswell, University of Minnesota, Minneapolis; Elsayed Z Soliman, Wake Forest University; Rebecca Gottesman, Johns Hopkins University; Thomas Mosley, University of Mississippi; Alvaro Alonso, Emory University; Amil Shah, Brigham and Women's Hospital, Boston; Scott D Solomon, Brigham and Women's Hospital, Boston; Lin Yee Chen, University of Minnesota, Minneapolis
• Journal Title: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: Volume 11, Number 9
• Publisher: WILEY | 2022-05-03, Pages e024292-e024292
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.121.024292
• Subjects: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; 3-dimensional echocardiography; left atrial function; left atrial stiffness; left atrial strain; subclinical cerebral infarctions; CORONARY-HEART-DISEASE; ATHEROSCLEROSIS RISK; CEREBRAL INFARCTION; FAILURE; FIBRILLATION; ECHOCARDIOGRAPHY; SURVIVAL; DESIGN; UPDATE; ADULTS

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.