Left Atrial Strain Provides Incremental Value for Embolism Risk Stratification over CHA2DS2-VASc Score and Indicates Prognostic Impact in Patients with Atrial Fibrillation

Obokata, Masaru; Negishi, Kazuaki; Kurosawa, Koji; Tateno, Rieko; Tange, Shoichi; Arai, M.; Amano, Masao; Kurabayashi, Masahiko

doi:10.1016/j.echo.2014.03.010

Cited by 148 publications

(105 citation statements)

References 33 publications

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“…21 LA reservoir function represents a more advanced state of LA remodeling than LA enlargement alone. 22 These previous studies have shown associations between structural or functional remodeling in LA and risk stratification schemes [9][10][11] but not in light of sex differences.…”

Section: Discussionmentioning

confidence: 99%

“…5 Previous studies have identified several LA echocardiographic parameters as risk factors for embolic stroke, including LA emptying fraction (LAEF), volume (LAV), LA appendage flow velocity, the presence of a thrombus, and spontaneous echo contrast. 6 Recently, speckle-tracking echocardiography has enabled a precise assessment of the function of the LA not only during sinus rhythm 7,8 but also during AF, [9][10][11][12] where reduced LA strain is associated with stroke. [9][10][11][12] We hypothesized that there are significant interactions between sex and stroke risk on LA anatomy and mechanics.…”

Section: See Editorial By Labovitz and Meriwether See Clinical Perspementioning

confidence: 99%

“…6 Recently, speckle-tracking echocardiography has enabled a precise assessment of the function of the LA not only during sinus rhythm 7,8 but also during AF, [9][10][11][12] where reduced LA strain is associated with stroke. [9][10][11][12] We hypothesized that there are significant interactions between sex and stroke risk on LA anatomy and mechanics. Thus, the aims of this study were to determine whether LA mechanics, including LAEF and LA strain, were more impaired in women than in men and elucidate whether there are any interactions of sex and risk stratification schemes (CHADS 2 and CHA 2 DS 2 -VASc scores without a sex category) on LA anatomy and mechanics.…”

Section: See Editorial By Labovitz and Meriwether See Clinical Perspementioning

confidence: 99%

“…11 In brief, 3 consecutive cardiac cycles were recorded and averaged for the patients with sinus rhythm and 5 for those with AF, and the frame rate was set at 60 to 80 frames per second. The analysis was performed off-line using proprietary software (EchoPAC ver12.0, GE, Milwaukee, WI).…”

Section: Speckle-tracking Echocardiographymentioning

confidence: 99%

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Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

Yoshida

Obokata

Kurosawa

et al. 2016

Circ: Cardiovascular Imaging

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Background-Embolic stroke in atrial fibrillation is more prevalent in women than in men, yet the basis for this difference remains unclear. This study seeks to elucidate whether there are any sex differences in the relationships between stroke risk (CHADS 2 score, CHA 2 DS 2 -VASc score without a sex category, and estimated stroke rate) and left atrial (LA) anatomy or mechanics in patients with atrial fibrillation. Methods and Results-LA emptying fraction and global peak atrial longitudinal strain were assessed in 414 subjects with paroxysmal or persistent atrial fibrillation (156 women and 258 men). Linear regression models with an interaction term were performed to test the effect of sex difference on associations between the embolic risk and LA function or anatomy. Sensitivity analyses were performed in 228 age, heart rate, and rhythm-matched subjects (114 women and men). Women were older and had larger LA volumes and lower LA mechanics than men. Significant negative association between the CHADS 2 score and LA emptying fraction was only demonstrated in women with a significant interaction between sexes. Similar significant interactions were found in global peak atrial longitudinal strain but not in LA volume. These findings were corroborated in the comparisons against CHA 2 DS 2 -VASc score without a sex category and the estimated stroke rate. Sensitivity analyses in the matched subgroup also confirmed the robustness of these sex differences in LA emptying fraction, but less so in global peak atrial longitudinal strain. Conclusions-Significant sex interactions on the association between global LA function and risk stratification schemes exist, which may be a reason for the higher prevalence of embolic stroke in women. (Circ Cardiovasc Imaging. 2016;9:e004999.

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Section: Discussionmentioning

confidence: 99%

Section: See Editorial By Labovitz and Meriwether See Clinical Perspementioning

confidence: 99%

Section: See Editorial By Labovitz and Meriwether See Clinical Perspementioning

confidence: 99%

Section: Speckle-tracking Echocardiographymentioning

confidence: 99%

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Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

Yoshida

Obokata

Kurosawa

et al. 2016

Circ: Cardiovascular Imaging

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“…Obokata et al (103) demonstrated that global LA systolic strain was independently associated with acute embolism in patients with paroxysmal or persistent AF, and provided incremental diagnostic value over the CHA2DS2-VASc score. In another retrospective case-control study (104), reduced LA systolic strain was associated with increased risk of stroke and transient ischemic attacks in patients with paroxysmal AF and low CHADS2 scores (≤1 prior to stroke).…”

Section: La Strain and Strokementioning

confidence: 99%

Left atrial function: evaluation by strain analysis

Gan¹,

Ferkh²,

Boyd

et al. 2018

Cardiovasc. Diagn. Ther.

140

108

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Abstract:The left atrium has an important role in modulating left ventricular filling and is an important biomarker of cardiovascular disease and adverse cardiovascular outcomes. While previously left atrial (LA) size was utilised, the role of LA function as a biomarker is increasingly being evaluated, both independently and also in combination with LA size. Strain analysis has been utilised for evaluation of LA function and can be measured throughout the cardiac cycle, thereby enabling the evaluation of LA reservoir, conduit and contractile function. Strain evaluates myocardial deformation while strain rate examines the rate of change in strain. This review will focus on the various types of strain analysis for evaluation of LA function, alterations in LA strain in physiological and pathologic states that alter LA function and finally evaluate its utility as a prognostic marker.

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Association of Left Atrial Strain With Ischemic Stroke Risk in Older Adults

et al. 2023

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ImportanceThe risk of ischemic stroke is higher among patients with left atrial (LA) enlargement. Left atrial strain (LAε) and LA strain rate (LASR) may indicate LA dysfunction when LA volumes are still normal. The association of LAε with incident ischemic stroke in the general population is not well established.ObjectiveTo investigate whether LAε and LASR are associated with new-onset ischemic stroke among older adults.DesignThe Cardiovascular Abnormalities and Brain Lesions study was conducted from September 29, 2005, to July 6, 2010, to investigate cardiovascular factors associated with subclinical cerebrovascular disease. A total of 806 participants in the Northern Manhattan Study who were aged 55 years or older without history of prior stroke or atrial fibrillation (AF) were included, and annual follow-up telephone interviews were completed May 22, 2022. Statistical analysis was performed from June through November 2022.ExposuresLeft atrial strain and LASR were assessed by speckle-tracking echocardiography. Global peak positive longitudinal LAε and positive longitudinal LASR during ventricular systole, global peak negative longitudinal LASR during early ventricular diastole, and global peak negative longitudinal LASR during LA contraction were measured. Brain magnetic resonance imaging was used to detect silent brain infarcts and white matter hyperintensities at baseline.Main Outcomes and MeasuresRisk analysis with cause-specific Cox proportional hazards regression modeling was used to assess the association of positive longitudinal LAε and positive longitudinal LASR with incident ischemic stroke, adjusting for other stroke risk factors, including incident AF.ResultsThe study included 806 participants (501 women [62.2%]) with a mean (SD) age of 71.0 (9.2) years; 119 participants (14.8%) were Black, 567 (70.3%) were Hispanic, and 105 (13.0%) were White. During a mean (SD) follow-up of 10.9 (3.7) years, new-onset ischemic stroke occurred in 53 participants (6.6%); incident AF was observed in 103 participants (12.8%). Compared with individuals who did not develop ischemic stroke, participants with ischemic stroke had lower positive longitudinal LAε and positive longitudinal LASR at baseline. In multivariable analysis, the lowest (ie, closest to zero) vs all other quintiles of positive longitudinal LAε (adjusted hazard ratio [HR], 3.12; 95% CI, 1.56-6.24) and negative longitudinal LASR during LA contraction (HR, 2.89; 95% CI, 1.44-5.80) were associated with incident ischemic stroke, independent of left ventricular global longitudinal strain and incident AF. Among participants with a normal LA size, the lowest vs all other quintiles of positive longitudinal LAε (HR, 4.64; 95% CI, 1.55-13.89) and negative longitudinal LASR during LA contraction (HR, 11.02; 95% CI 3.51-34.62) remained independently associated with incident ischemic stroke.Conclusions and RelevanceThis cohort study suggests that reduced positive longitudinal LAε and positive longitudinal LASR are independently associated with ischemic stroke in older adults. Assessment of LAε and LASR by speckle-tracking echocardiography may improve stroke risk stratification in elderly individuals.

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Left Atrial Strain Provides Incremental Value for Embolism Risk Stratification over CHA2DS2-VASc Score and Indicates Prognostic Impact in Patients with Atrial Fibrillation

Cited by 148 publications

References 33 publications

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

Left atrial function: evaluation by strain analysis

Association of Left Atrial Strain With Ischemic Stroke Risk in Older Adults

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