title: LA volumes and reservoir function are associated with subclinical cerebrovascular disease: the CABL (Cardiovascular Abnormalities and Brain Lesions) study.
abstract: OBJECTIVE
  The purpose of this study was to assess the relationship of left atrial (LA) phasic volumes and LA reservoir function with subclinical cerebrovascular disease in a stroke-free community-based cohort.
  
  
  BACKGROUND
  An increase in LA size is associated with cardiovascular events including stroke. However, it is not known whether LA phasic volumes and reservoir function are associated with subclinical cerebrovascular disease.
  
  
  METHODS
  The LA minimum (LAV(min)) and maximum (LAV(max)) volumes, and LA reservoir function, measured as total emptying volume (LAEV) and total emptying fraction (LAEF), were assessed by real-time 3-dimensional echocardiography in 455 stroke-free participants from the community-based CABL (Cardiovascular Abnormalities and Brain Lesions) study. Subclinical cerebrovascular disease was assessed as silent brain infarcts (SBI) and white matter hyperintensity volume (WMHV) by brain magnetic resonance imaging.
  
  
  RESULTS
  Prevalence of SBI was 15.4%; mean WMHV was 0.66 ± 0.92%. Participants with SBI showed greater LAV(min) (17.1 ± 9.3 ml/m(2) vs. 12.5 ± 5.6 ml/m(2), p < 0.01) and LAV(max) (26.6 ± 8.8 ml/m(2) vs. 23.3 ± 7.0 ml/m(2), p < 0.01) compared to those without SBI. The LAEV (9.5 ± 3.4 ml/m(2) vs. 10.8 ± 3.9 ml/m(2), p < 0.01) and LAEF (38.7 ± 14.7% vs. 47.0 ± 11.9%, p < 0.01) were also reduced in participants with SBI. In univariate analyses, greater LA volumes and smaller reservoir function were significantly associated with greater WMHV. In multivariate analyses, LAV(min) remained significantly associated with SBI (adjusted odds ratio per SD increase: 1.37, 95% confidence interval: 1.04 to 1.80, p < 0.05) and with WMHV (β = 0.12, p < 0.01), whereas LAVmax was not independently associated with either. Smaller LAEF was independently associated with SBI (adjusted odds ratio: 0.67, 95% confidence interval: 0.50 to 0.90, p < 0.01) and WMHV (β = -0.09, p < 0.05).
  
  
  CONCLUSIONS
  Greater LA volumes and reduced LA reservoir function are associated with subclinical cerebrovascular disease detected by brain magnetic resonance imaging in subjects without history of stroke. In particular, LAV(min) and LAEF are more strongly associated with SBI and WMHV than the more commonly measured LAVmax, and their relationship with subclinical brain lesions is independent of other cardiovascular risk factors.
authors.affiliation: Department of Medicine, Columbia University, New York, New York 10032, USA.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Rui
authors.initials: R
authors.lastname: Liu
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwata
authors.forename: Aylin
authors.initials: A
authors.lastname: Tugcu
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yoshita
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Charles
authors.initials: C
authors.lastname: Decarli
authors.forename: Clinton B
authors.initials: CB
authors.lastname: Wright
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D016279:Atrial Function, Left; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology