title: Functional Remodeling of Both Atria is Associated with Occurrence of Stroke in Patients with Paroxysmal and Persistent Atrial Fibrillation.
abstract: BACKGROUND
  It is critical to recognize high risk patients who are prone to develop stroke in the management of atrial fibrillation (AF). The purpose of this study was to identify the determinants of AF related stroke by assessing the anatomical and functional remodeling of cardiac chambers.
  
  
  METHODS
  We compared the cardiac structure and function of 28 consecutive patients with paroxysmal and persistent AF-related stroke with 69 patients with AF and 21 controls without stroke using contrast-enhanced 64-slice multi-detector computed tomography during sinus rhythm.
  
  
  RESULTS
  The volume of left atrium (LA), LA appendage (LAA) and right atrium (RA) were significantly increased across the groups with sinus rhythm (SR), AF and AF-related stroke (p < 0.001 for each, respectively). The emptying fraction and booster-pump function of LA, LAA and RA were decreased across the groups (p < 0.001 for each). In addition, the left ventricular mass index was increased in AF related stroke (p = 0.003). Using multivariate analysis, increased age (p = 0.003), reduced booster-pump function of LA (p = 0.01), LAA (p < 0.001) and RA (p < 0.001) were shown to be independently associated with the occurrence of stroke.
  
  
  CONCLUSIONS
  The dilatation and contractile dysfunction of both atria are related to the development of stroke in patients with paroxysmal and persistent AF. Our results suggested that the use of substrate-based assessment may help improve risk stratification of stroke in patients with AF.
authors.affiliation: Division of Cardiology, National Yang Ming University Hospital, Yi-Lan.
authors.forename: Hsuan-Ming
authors.initials: HM
authors.lastname: Tsao
authors.affiliation: Department of Biomedical Engineering, Chung-Yuan Christian University, Chungli.
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Hu
authors.affiliation: Division of Neurology.
authors.forename: Ping-Huang
authors.initials: PH
authors.lastname: Tsai
authors.affiliation: Division of Neurology.
authors.forename: Chao-Lin
authors.initials: CL
authors.lastname: Lee
authors.affiliation: Department of Radiology, National Yang Ming University Hospital.
authors.forename: Hsueh-Han
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Cardiovascular Research Center, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan.
authors.forename: Shih-Lin
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Cardiovascular Research Center, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan.
authors.forename: Tze-Fan
authors.initials: TF
authors.lastname: Chao
authors.affiliation: Cardiovascular Research Center, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan.
authors.forename: Shih-Ann
authors.initials: SA
authors.lastname: Chen
keywords: Atrial fibrillation; Multi-detector computed tomography; Remodeling; Stroke