Left atrial strain provides incremental value for embolism risk stratification over CHA₂DS₂-VASc score and indicates prognostic impact in patients with atrial fibrillation.
BACKGROUND
The aim of this study was to investigate whether left atrial (LA) strain has incremental value over the CHA2DS2-VASc score for stratifying the risk for embolism in patients with atrial fibrillation (AF) and whether LA strain predicts poststroke mortality.


METHODS
Consecutive patients with paroxysmal or persistent AF with acute embolism (82 patients) or without (204 controls) were prospectively enrolled. Global peak LA longitudinal strain during ventricular systole (LAS) was assessed during AF rhythm. Global LAS was compared between the groups in the first cross-sectional study. Then, the 82 patients with acute embolism were prospectively followed during the second prospective cohort study.


RESULTS
Global LAS was lower in patients with acute embolism than in controls (P < .001). Global LAS < 15.4% differentiated patients with acute embolism from controls, with an area under the curve of 0.83 (P < .0001). In multivariate analysis, global LAS was independently associated with acute embolism (odds ratio, 0.74; 95% confidence interval, 0.67-0.82; P < .001) and had an incremental value over the CHA2DS2-VASc score (P < .0001). Furthermore, 26 patients with acute embolisms died during a median follow-up period of 425 days. Global LAS independently predicted mortality after embolism.


CONCLUSIONS
In this observational study, LA strain provided incremental diagnostic information over that provided by the CHA2DS2-VASc score, suggesting that LA strain analysis could improve the current risk stratification of embolism in patients with AF. LA strain can also predict poststroke mortality.
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Masaru
M
Obokata
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; Menzies Research Institute Tasmania, Hobart, Tasmania, Australia. Electronic address: kazz.negishi@nifty.com.
Kazuaki
K
Negishi
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Koji
K
Kurosawa
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Rieko
R
Tateno
Department of Cardiovascular Medicine, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan.
Shoichi
S
Tange
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Masashi
M
Arai
Department of Cardiovascular Medicine, Geriatrics Research Institute and Hospital, Maebashi, Gunma, Japan.
Masao
M
Amano
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Masahiko
M
Kurabayashi
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016279:Atrial Function, Left / Q000502:physiology*; D064752:Atrial Remodeling / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013923:Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
Atrial fibrillation; Left atrial function; Left atrial strain; Speckle-tracking; Stroke