title: Left ventricular diastolic dysfunction is associated with atrial remodeling and risk or presence of stroke in patients with paroxysmal atrial fibrillation.
abstract: Although the degree of electroanatomical remodeling of the left atrium (LA) is influenced by left ventricular (LV) diastolic function, clinical implications of estimated LV filling pressure (E/Em) are limited in patients with atrial fibrillation (AF). We hypothesized that increased E/Em is related to an advanced LA remodeling, a high CHA2DS2-VASc score, and the presence of stroke or transient ischemic attack (TIA) in patients with paroxysmal AF.
  
  
  
  We included 1098 patients with paroxysmal AF (male 74.5%, 57.6±11.3 years old) who underwent AF catheter ablation. We compared E/Em to clinical parameters, echocardiography, and three-dimensional-computed tomography findings.
  
  
  
  The E/Em>15 group (n=98) was older (p<0.001) and had more females (p<0.001), greater LA volume index (p<0.001), higher CHA2DS2-VASc score (p<0.001), and stroke/TIA prevalence (p=0.001) than groups with an E/Em of 8-15 (n=676) or <8 (n=324). An E/Em was independently associated with the presence of stroke/TIA (OR 1.638, 95% CI 1.050-2.554, p=0.030) after adjusting for age, sex, body surface area, LA volume index, and LA appendage volume index.
  
  
  
  In patients with paroxysmal AF, the elevated LV filling pressure estimated by E/Em is independently associated with the presence of stroke or TIA.
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Park
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Nam
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea. Electronic address: hnpak@yuhs.ac.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D000367:Age Factors; D000368:Aged; D020517:Atrial Appendage / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D064752:Atrial Remodeling; D017115:Catheter Ablation / Q000379:methods; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000209:etiology*; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: Atrial fibrillation; Catheter ablation; Left ventricular filling pressure; Stroke