Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS(2) scores.
BACKGROUND
Left atrial (LA) strain as a marker for discrimination of risk for stroke and transient ischemic attack (TIA) in patients with atrial fibrillation and low-risk CHADS(2) scores (≤1) has yet to be examined.


METHODS
Patients with atrial fibrillation, stroke or TIA, and CHADS(2) scores ≤ 1 before their events were identified retrospectively from a large single-center stroke registry and compared with age-matched and gender-matched controls. Antihypertensive use and echocardiographic parameters including chamber volumes and left ventricular mass and LA peak negative and positive strain and strain rate were compared between groups.


RESULTS
Fifty-seven patients meeting entry criteria were identified. Patients demonstrated significantly lower left ventricular ejection fractions, larger LA dimensions, and larger LA volume indexes (24.4 ± 11.9 vs 32.3 ± 13.3 mL/m(2), P = .012) compared with controls. Both peak negative LA strain (-3.2 ± 1.2% vs -6.9 ± 4.2%, P < .001) and peak positive LA strain (14 ± 11% vs 25 ± 12%, P < .001) were significantly reduced in patients compared with controls. Peak negative LA strain was significantly associated with stroke by binary logistic regression (odds ratio, 2.15; P < .001).


CONCLUSIONS
In patients with low-risk CHADS(2) scores, atrial fibrillation, and stroke or TIA, reduced LA strain is a potentially sensitive maker for increased risk for stroke or TIA. These results suggest that LA strain may have potential as a tool for helping guide the decision for or against oral anticoagulation in this group of patients.
Henry Low Heart Center, Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA.
Talhat
T
Azemi
Vimal M
VM
Rabdiya
Srilatha R
SR
Ayirala
Louise D
LD
McCullough
David I
DI
Silverman
D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D003237:Connecticut / Q000453:epidemiology; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D012042:Registries; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology