Quantitative tissue-tracking cardiac magnetic resonance (CMR) of left atrial deformation and the risk of stroke in patients with atrial fibrillation.
BACKGROUND
Recent evidence suggests that left atrial (LA) dysfunction may be mechanistically contributing to cerebrovascular events in patients with atrial fibrillation (AF). We investigated the association between regional LA function and a prior history of stroke during sinus rhythm in patients referred for catheter ablation of AF.


RESULTS
A total of 169 patients (59 ± 10 years, 74% male, 29% persistent AF) with a history of AF in sinus rhythm at the time of pre-ablation cardiac magnetic resonance (CMR) were analyzed. The LA volume, emptying fraction, strain (S), and strain rate (SR) were assessed by tissue-tracking cardiac magnetic resonance. The patients with a history of stroke or transient ischemic attack (n=18) had greater LA volumes (Vmax and Vmin; P=0.02 and P<0.001, respectively), lower LA total emptying fraction (P<0.001), lower LA maximum and pre-atrial contraction strains (Smax and SpreA; P<0.001 and P=0.01, respectively), and lower absolute values of LA SR during left ventricular (LV) systole and early diastole (SRs and SRe; P=0.005 and 0.03, respectively) than those without stroke/transient ischemic attack (n=151). Multivariable analysis demonstrated that the LA reservoir function, including total emptying fraction, Smax, and SRs, was associated with stroke/transient ischemic attack (odds ratio 0.94, 0.91, and 0.17; P=0.03, 0.02, and 0.04, respectively) after adjusting for the CHA2DS2-VASc score and LA Vmin.


CONCLUSIONS
Depressed LA reservoir function assessed by tissue-tracking cardiac magnetic resonance is significantly associated with a prior history of stroke/transient ischemic attack in patients with AF. Our findings suggest that assessment of LA reservoir function can improve the risk stratification of cerebrovascular events in AF patients.
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.).
Yuko Y
YY
Inoue
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.).
Abdullah
A
Alissa
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.).
Irfan M
IM
Khurram
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.).
Kotaro
K
Fukumoto
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.).
Mohammadali
M
Habibi
The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (B.A.V., S.L.Z.).
Bharath A
BA
Venkatesh
The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (B.A.V., S.L.Z.).
Stefan L
SL
Zimmerman
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.) Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD (S.N.).
Saman
S
Nazarian
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.) Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD (R.D.B., H.A.).
Ronald D
RD
Berger
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.).
Hugh
H
Calkins
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.).
Joao A
JA
Lima
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (Y.Y.I., A.A., I.M.K., K.F., M.H., S.N., R.D.B., H.C., J.A.L., H.A.) Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD (R.D.B., H.A.).
Hiroshi
H
Ashikaga
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D016279:Atrial Function, Left / Q000502:physiology*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology
atrial fibrillation; atrial strain; magnetic resonance imaging; stroke; tracking