Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm
Background Stroke is a major comorbidity in patients with heart failure (HF), especially in those with decreased left atrial (LA) function, and thus, identifying patients highly at risk of stroke can prevent its occurrence. We evaluated the predictive value of global longitudinal strain of LA (LAGLS...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.020414 |
| _version_ | 1797936133474091008 |
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| author | Jae‐Hyeong Park In‐Chang Hwang Jin Joo Park Jun‐Bean Park Goo‐Yeong Cho |
| author_facet | Jae‐Hyeong Park In‐Chang Hwang Jin Joo Park Jun‐Bean Park Goo‐Yeong Cho |
| author_sort | Jae‐Hyeong Park |
| collection | DOAJ |
| description | Background Stroke is a major comorbidity in patients with heart failure (HF), especially in those with decreased left atrial (LA) function, and thus, identifying patients highly at risk of stroke can prevent its occurrence. We evaluated the predictive value of global longitudinal strain of LA (LAGLS) in patients with acute HF and sinus rhythm. Methods and Results In this retrospective study, 2461 patients (53.3% men, 69.7±14.4 years old) with sinus rhythm and LAGLS among 4312 consecutive patients with acute HF from 3 tertiary hospitals were included. HF phenotypes were defined as HF with reduced ejection fraction (EF) (left ventricular EF ≤40%), HF with midrange EF (40% <left ventricular EF <50%), and HF with preserved ejection fraction (left ventricular EF ≥50%). Primary outcome was new‐onset stroke. The mean left ventricular EF was 39.4%±15.6%. Moreover, 1388 (57.5%), 342 (14.2%), and 682 (28.3%) were classified with HF with reduced EF, HF with midrange EF, and HF with preserved EF, retrospectively. LAGLS was 17.2%±10.4%. During the follow‐up duration (mean: 30.3±25.4 months), 100 patients experienced stroke. Patients with stroke had higher LA diameter (P=0.031) and lower LAGLS (P=0.010) than those without stroke. In the univariate analysis, age, diabetes mellitus, LA diameter, LA volume index, and LAGLS were significant risk factors for stroke. In the multivariate analysis, each 1% decrease in LAGLS was associated with a 3.8% increased risk for stroke (hazard ratio [HR], 1.038; 95% CI, 1.013–1.065; P=0.003). When applying a LAGLS cutoff point of 14.5%, patients with LAGLS <14.5% had approximately twice the risk for stroke after adjusting other significant variables (HR, 1.940; 95% CI, 1.269–2.965; P=0.002). Conclusions In patients with acute HF and sinus rhythm, decreased LAGLS (<14.5%) was associated with an increased risk for stroke, with an annual incidence of 2.38%. |
| first_indexed | 2024-04-10T18:24:59Z |
| format | Article |
| id | doaj.art-dd666d265a1a4d90b93a3553db66cebe |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T18:24:59Z |
| publishDate | 2021-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-dd666d265a1a4d90b93a3553db66cebe2023-02-02T06:18:05ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-07-01101310.1161/JAHA.120.020414Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus RhythmJae‐Hyeong Park0In‐Chang Hwang1Jin Joo Park2Jun‐Bean Park3Goo‐Yeong Cho4Department of Cardiology in Internal Medicine Chungnam National University HospitalChungnam National University College of Medicine Daejeon KoreaCardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam KoreaCardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam KoreaDepartment of Internal Medicine Seoul National University College of MedicineSeoul National University Hospital Seoul KoreaCardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam KoreaBackground Stroke is a major comorbidity in patients with heart failure (HF), especially in those with decreased left atrial (LA) function, and thus, identifying patients highly at risk of stroke can prevent its occurrence. We evaluated the predictive value of global longitudinal strain of LA (LAGLS) in patients with acute HF and sinus rhythm. Methods and Results In this retrospective study, 2461 patients (53.3% men, 69.7±14.4 years old) with sinus rhythm and LAGLS among 4312 consecutive patients with acute HF from 3 tertiary hospitals were included. HF phenotypes were defined as HF with reduced ejection fraction (EF) (left ventricular EF ≤40%), HF with midrange EF (40% <left ventricular EF <50%), and HF with preserved ejection fraction (left ventricular EF ≥50%). Primary outcome was new‐onset stroke. The mean left ventricular EF was 39.4%±15.6%. Moreover, 1388 (57.5%), 342 (14.2%), and 682 (28.3%) were classified with HF with reduced EF, HF with midrange EF, and HF with preserved EF, retrospectively. LAGLS was 17.2%±10.4%. During the follow‐up duration (mean: 30.3±25.4 months), 100 patients experienced stroke. Patients with stroke had higher LA diameter (P=0.031) and lower LAGLS (P=0.010) than those without stroke. In the univariate analysis, age, diabetes mellitus, LA diameter, LA volume index, and LAGLS were significant risk factors for stroke. In the multivariate analysis, each 1% decrease in LAGLS was associated with a 3.8% increased risk for stroke (hazard ratio [HR], 1.038; 95% CI, 1.013–1.065; P=0.003). When applying a LAGLS cutoff point of 14.5%, patients with LAGLS <14.5% had approximately twice the risk for stroke after adjusting other significant variables (HR, 1.940; 95% CI, 1.269–2.965; P=0.002). Conclusions In patients with acute HF and sinus rhythm, decreased LAGLS (<14.5%) was associated with an increased risk for stroke, with an annual incidence of 2.38%.https://www.ahajournals.org/doi/10.1161/JAHA.120.020414heart failurestrain echocardiographystroke |
| spellingShingle | Jae‐Hyeong Park In‐Chang Hwang Jin Joo Park Jun‐Bean Park Goo‐Yeong Cho Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure strain echocardiography stroke |
| title | Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm |
| title_full | Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm |
| title_fullStr | Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm |
| title_full_unstemmed | Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm |
| title_short | Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm |
| title_sort | left atrial strain to predict stroke in patients with acute heart failure and sinus rhythm |
| topic | heart failure strain echocardiography stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.020414 |
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