title: Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation.
abstract: BACKGROUND
  Embolic stroke in atrial fibrillation is more prevalent in women than in men, yet the basis for this difference remains unclear. This study seeks to elucidate whether there are any sex differences in the relationships between stroke risk (CHADS2score, CHA2DS2-VASc score without a sex category, and estimated stroke rate) and left atrial (LA) anatomy or mechanics in patients with atrial fibrillation.
  
  
  RESULTS
  LA emptying fraction and global peak atrial longitudinal strain were assessed in 414 subjects with paroxysmal or persistent atrial fibrillation (156 women and 258 men). Linear regression models with an interaction term were performed to test the effect of sex difference on associations between the embolic risk and LA function or anatomy. Sensitivity analyses were performed in 228 age, heart rate, and rhythm-matched subjects (114 women and men). Women were older and had larger LA volumes and lower LA mechanics than men. Significant negative association between the CHADS2score and LA emptying fraction was only demonstrated in women with a significant interaction between sexes. Similar significant interactions were found in global peak atrial longitudinal strain but not in LA volume. These findings were corroborated in the comparisons against CHA2DS2-VASc score without a sex category and the estimated stroke rate. Sensitivity analyses in the matched subgroup also confirmed the robustness of these sex differences in LA emptying fraction, but less so in global peak atrial longitudinal strain.
  
  
  CONCLUSIONS
  Significant sex interactions on the association between global LA function and risk stratification schemes exist, which may be a reason for the higher prevalence of embolic stroke in women.
authors.affiliation: From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.).
authors.forename: Kuniko
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.).
authors.forename: Masaru
authors.initials: M
authors.lastname: Obokata
authors.affiliation: From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.).
authors.forename: Koji
authors.initials: K
authors.lastname: Kurosawa
authors.affiliation: From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.).
authors.forename: Hidemi
authors.initials: H
authors.lastname: Sorimachi
authors.affiliation: From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.).
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kurabayashi
authors.affiliation: From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.). Kazuaki.Negishi@utas.edu.au.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Negishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D016279:Atrial Function, Left; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D054624:Health Status Disparities; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013314:Stress, Mechanical; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology
keywords: atrial fibrillation; heart rate; left atrial emptying fraction; male; prevalence