title: Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation.
abstract: BACKGROUND
  The objective of this study was to investigate myocardial deformation of the left atrium (LA) assessed by two-dimensional speckle tracking echocardiography in patients with permanent atrial fibrillation (AF) and its value for risk stratification for stroke.
  
  
  METHODS
  We recruited 66 consecutive patients with permanent AF who were referred to our echocardiography laboratory for evaluation. These patients were divided into two groups according to the presence of previous stroke or not.
  
  
  RESULTS
  Peak positive longitudinal strain (LASp) during atrial filling, peak strain rate in the reservoir phase of LA (LASRr), and peak strain rate in the conduit phase (LASRc) were identified from LA strain and strain rate curves. The ratio of peak early filling velocity (E) of mitral inflow to early diastolic annulus velocity (E') of the medial annulus (E/E') was calculated. LASp (10.44% ± 4.2% vs. 15.69% ± 5.1%, P < .001), LASRr (1.09 ± 0.27 1/s vs. 1.37 ± 0.32 1/s, P = .001), and LASRc (-1.28 ± 0.38 1/s vs. -1.62 ± 0.43 1/s, P = .002) were significantly lower in patients with AF with stroke than those without stroke. By multivariate analysis controlling for age, LA volume index, and left ventricular ejection fraction, LASp (OR 0.787, 95% CI, 0.639-0.968, P = .023) and LASRr (OR 0.019, 95% CI, 0.001-0.585, P = .023) were independently associated with stroke but not LASRc, E', and E/E' ratio.
  
  
  CONCLUSIONS
  Decreased LASp and LASRr were independently associated with stroke in patients with permanent AF.
authors.affiliation: Tainan Hospital Sin-Hua Branch, Tainan, Taiwan.
authors.forename: Jhih-Yuan
authors.initials: JY
authors.lastname: Shih
authors.forename: Wei-Chuan
authors.initials: WC
authors.lastname: Tsai
authors.forename: Yao-Yi
authors.initials: YY
authors.lastname: Huang
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Liu
authors.forename: Chih-Chan
authors.initials: CC
authors.lastname: Lin
authors.forename: Yu-Shan
authors.initials: YS
authors.lastname: Huang
authors.forename: Liang-Miin
authors.initials: LM
authors.lastname: Tsai
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Lin
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D016279:Atrial Function, Left; D016001:Confidence Intervals; D003971:Diastole; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D020521:Stroke / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D013318:Stroke Volume; D014463:Ultrasonography; D016277:Ventricular Function, Left