Detection of left atrial mechanical dysfunction by measurement of left atrial reservoir strain improves stroke prediction in persons without a history of atrial fibrillation or stroke

Abstract: https://www.acpjournals.org/doi/10.7326/M22-1638    

Editorial: https://www.acpjournals.org/doi/10.7326/M22-3476    

URL goes live when the embargo lifts

A cohort study of more than 4,500 persons without a history of atrial fibrillation (AF) or stroke has found that measuring left atrial mechanical function can improve stroke prediction. The findings are published in Annals of Internal Medicine.

AF is a serious public health problem because of its increasing prevalence in the aging population and its association with risks of cardiac thromboembolism and stroke. An intrinsically pro-thrombotic atrial myopathy, characterized by changes in left atrial mechanical function and size, may precede and promote development of AF. Evaluating left atrial mechanics and size may have utility in enhancing prediction of cardiac embolism and stroke earlier in a patient’s disease course before development of AF.

Researchers from multiple institutions including the Pennsylvania State University, University of California Los Angeles, and the University of Minnesota evaluated data from 4,917 persons participating in the ARIC (Atherosclerosis Risk in Communities) study. The authors found that left atrial mechanical dysfunction, detected by analysis of left atrial strain, was associated with ischemic stroke independently of left atrial size and risk factors from the CHA₂DS₂-VASc score. They also found that the addition of left atrial reservoir strain to the CHA₂DS₂-VASc variables improved stroke prediction and yielded a greater predicted net benefit, as shown by decision curve analysis. According to the authors, the results of this study support the hypothesis that atrial myopathy, characterized by left atrial mechanical dysfunction, is intrinsically prothrombotic, resulting in higher risk for cardiac embolism and ischemic stroke.

An accompanying editorial from authors at the Boston University Chobanian and Avedisian School of Medicine applauds the study authors for bringing attention to the possible role of atrial cardiopathy in mediating cardioembolic stroke in the absence of AF and explains the real-world importance of their findings.

Media contacts: For an embargoed PDF, please contact Addison Dunlap at [email protected]. To speak with corresponding author Ankit Maheshwari, MD, MS, email  [email protected] or reach out to Rachael Gage at [email protected].