title: Relationship between tissue Doppler measurements of left ventricular diastolic function and silent brain infarction in patients with non-valvular atrial fibrillation.
abstract: OBJECTIVE
  Left ventricular (LV) diastolic function assessed by tissue Doppler imaging (TDI) is reported to be associated with left atrial (LA) blood stasis in patients with non-valvular atrial fibrillation (AF). This study aimed to evaluate the relationship of diastolic TDI parameters with silent brain infarction (SBI) on brain magnetic resonance imaging (MRI), and in turn the risks of subsequent stroke or dementia, in non-valvular AF patients.
  
  
  RESULTS
  The study population consisted of 171 neurologically asymptomatic patients with non-valvular AF who underwent transoesophageal echocardiography (TOE) (128 men; mean age, 63 ± 11 years). We measured diastolic TDI parameters by transthoracic echocardiography, and also screened for SBI employing brain MRI. Early transmitral flow velocity (E) and mitral annular velocity by TDI (e') were measured, and E/e' ratios were calculated. An increased tertile of the E/e' ratio was significantly related to high prevalences of LA abnormalities detected by TOE (32% vs. 12% vs. 9%; P =0.002) and SBI on brain MRI (46% vs. 23% vs. 14%; P < 0.001). In multivariate logistic regression analyses after adjustment for age, hypertension, chronic kidney disease, and CHA2DS2-VASc score ≥2, the E/e' ratio ≥12.4 was found to be an independent predictor of the presence of SBI (OR 3.98, 95% CI 1.74-9.07; P = 0.001).
  
  
  CONCLUSIONS
  Impaired LV diastolic function evaluated by increased E/e' ratio was closely associated with the presence of SBI independent of CHA2DS2-VASc score. TDI measurements are non-invasive and useful for risk stratification of the early stage of cerebral damages in patients with non-valvular AF.
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Sera
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugioka
authors.affiliation: Department of Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Suwako
authors.initials: S
authors.lastname: Fujita
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Asahiro
authors.initials: A
authors.lastname: Ito
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Norioka
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwata
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takagi
authors.affiliation: Department of Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Miki
authors.affiliation: Morinomiya University of Medical Science, Osaka, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Ueda
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: atrial fibrillation; echocardiography; silent brain infarction; tissue Doppler imaging