Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC‐NCS
Background Age‐related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3‐dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age i...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-05-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024292 |
| _version_ | 1798035916018679808 |
|---|---|
| author | Francesco Bianco Raffaele De Caterina Alvin Chandra Iolanda Aquila Brian Claggett Michelle C. Johansen Alexandra Gonçalves Faye L. Norby Rebecca Cogswell Elsayed Z. Soliman Rebecca Gottesman Thomas Mosley Alvaro Alonso Amil Shah Scott D. Solomon Lin Yee Chen |
| author_facet | Francesco Bianco Raffaele De Caterina Alvin Chandra Iolanda Aquila Brian Claggett Michelle C. Johansen Alexandra Gonçalves Faye L. Norby Rebecca Cogswell Elsayed Z. Soliman Rebecca Gottesman Thomas Mosley Alvaro Alonso Amil Shah Scott D. Solomon Lin Yee Chen |
| author_sort | Francesco Bianco |
| collection | DOAJ |
| description | Background Age‐related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3‐dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. Methods and Results We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC‐NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3‐dimensional echocardiographic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging–detectable infarcts (n=315), magnetic resonance imaging–diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain—a 3‐dimensional echocardiographic index of LA reservoir function—and E/e’ divided by LA global longitudinal strain—an index of LA stiffness—worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e’ divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. Conclusions In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age‐related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke. |
| first_indexed | 2024-04-11T21:05:04Z |
| format | Article |
| id | doaj.art-83565d5b177744e4bce6f220291779af |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-11T21:05:04Z |
| publishDate | 2022-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-83565d5b177744e4bce6f220291779af2022-12-22T04:03:23ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-05-0111910.1161/JAHA.121.024292Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC‐NCSFrancesco Bianco0Raffaele De Caterina1Alvin Chandra2Iolanda Aquila3Brian Claggett4Michelle C. Johansen5Alexandra Gonçalves6Faye L. Norby7Rebecca Cogswell8Elsayed Z. Soliman9Rebecca Gottesman10Thomas Mosley11Alvaro Alonso12Amil Shah13Scott D. Solomon14Lin Yee Chen15Department of Cardiovascular Medicine Brigham and Women's Hospital Boston MACardio‐Thoracic and Vascular Department, Pisa University Hospital, University of Pisa Pisa ItalyDepartment of Cardiovascular Medicine Brigham and Women's Hospital Boston MADepartment of Cardiovascular Medicine Brigham and Women's Hospital Boston MADepartment of Cardiovascular Medicine Brigham and Women's Hospital Boston MADepartment of Neurology The Johns Hopkins University School of Medicine Baltimore MDDepartment of Cardiovascular Medicine Brigham and Women's Hospital Boston MACenter for Cardiac Arrest Prevention, Department of Cardiology, Cedars‐Sinai Smidt Heart Institute, Los Angeles CALillehei Heart Institute and Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MNWake Forest University Winston‐Salem NCDepartment of Neurology The Johns Hopkins University School of Medicine Baltimore MDDepartment of Medicine University of Mississippi Medical Center Jackson MSDepartment of Epidemiology Rollins School of Public HealthEmory University Atlanta GADepartment of Cardiovascular Medicine Brigham and Women's Hospital Boston MADepartment of Cardiovascular Medicine Brigham and Women's Hospital Boston MALillehei Heart Institute and Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MNBackground Age‐related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3‐dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. Methods and Results We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC‐NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3‐dimensional echocardiographic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging–detectable infarcts (n=315), magnetic resonance imaging–diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain—a 3‐dimensional echocardiographic index of LA reservoir function—and E/e’ divided by LA global longitudinal strain—an index of LA stiffness—worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e’ divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. Conclusions In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age‐related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke.https://www.ahajournals.org/doi/10.1161/JAHA.121.0242923‐dimensional echocardiographyleft atrial functionleft atrial stiffnessleft atrial strainsubclinical cerebral infarctions |
| spellingShingle | Francesco Bianco Raffaele De Caterina Alvin Chandra Iolanda Aquila Brian Claggett Michelle C. Johansen Alexandra Gonçalves Faye L. Norby Rebecca Cogswell Elsayed Z. Soliman Rebecca Gottesman Thomas Mosley Alvaro Alonso Amil Shah Scott D. Solomon Lin Yee Chen Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC‐NCS Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 3‐dimensional echocardiography left atrial function left atrial stiffness left atrial strain subclinical cerebral infarctions |
| title | Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC‐NCS |
| title_full | Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC‐NCS |
| title_fullStr | Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC‐NCS |
| title_full_unstemmed | Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC‐NCS |
| title_short | Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC‐NCS |
| title_sort | left atrial remodeling and stroke in patients with sinus rhythm and normal ejection fraction aric ncs |
| topic | 3‐dimensional echocardiography left atrial function left atrial stiffness left atrial strain subclinical cerebral infarctions |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024292 |
| work_keys_str_mv | AT francescobianco leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT raffaeledecaterina leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT alvinchandra leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT iolandaaquila leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT brianclaggett leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT michellecjohansen leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT alexandragoncalves leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT fayelnorby leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT rebeccacogswell leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT elsayedzsoliman leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT rebeccagottesman leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT thomasmosley leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT alvaroalonso leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT amilshah leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT scottdsolomon leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs AT linyeechen leftatrialremodelingandstrokeinpatientswithsinusrhythmandnormalejectionfractionaricncs |