Author + information
- Received September 18, 2018
- Revision received January 28, 2019
- Accepted February 1, 2019
- Published online December 2, 2019.
- Mohammadali Habibi, MDa,b,
- Mytra Zareian, MDc,
- Bharath Ambale Venkatesh, PhDd,
- Sanaz Samiei, MDc,
- Masamichi Imai, MDe,
- Colin Wu, PhDf,
- Lenore J. Launer, PhDg,
- Steven Shea, MD, MSh,
- Rebecca F. Gottesman, MD, PhDi,
- Susan R. Heckbert, MD, PhDj,
- David A. Bluemke, MD, PhDk and
- João A.C. Lima, MDa,∗ ()
- aDivision of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- bDivision of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- cDepartment of Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- dDepartment of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- eDepartment of Radiology, Toranomon Hospital, Tokyo, Japan
- fOffice of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, Maryland
- gDivision of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland
- hDepartments of Medicine and Epidemiology, Columbia University, New York, New York
- iDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- jDepartment of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- kDepartment of Radiology, University of Wisconsin School of Medicine, Madison, Wisconsin
- ↵∗Address for correspondence:
Dr. João A.C. Lima, Johns Hopkins University, Division of Cardiology, 600 North Wolfe Street, Blalock 524D1, Baltimore, Maryland 21287.
Objectives This study sought to assess the association of baseline left atrial (LA) phasic function measured with cardia magnetic resonance (CMR) and incident ischemic cerebrovascular events (CVE).
Background LA remodeling is a known predictor of atrial fibrillation (AF), which is a risk factor for ischemic CVE. Despite studies showing an association between LA remodeling and ischemic CVE, the association of LA mechanical function with ischemic CVE in a population free of known cardiovascular disease is not fully studied.
Methods Phasic LA volumes; total, passive, and active LA emptying fractions (LAEF); and peak longitudinal LA strain were measured using feature-tracking CMR in 4,261 MESA (Multi-Ethnic Study of Atherosclerosis) participants (61 ± 10 years of age; 48% male). All individuals were free of clinical cardiovascular disease at baseline. Participants were followed for 11.6 ± 3.5 years for the diagnosis of incident ischemic CVE, defined as ischemic stroke or transient ischemic attack adjudicated by vascular neurologists.
Results During the follow-up, 193 (1.26 per 1,000 person-years) ischemic CVE (134 ischemic strokes and 59 TIAs) occurred. Individuals with incident ischemic CVE had larger LA volumes and lower passive, active, and total LAEFs at baseline. In multivariate analysis adjusted for known CVE risk factors, left ventricular mass and interim AF, total LAEF was associated with incident ischemic CVE (hazard ratio [HR]: 0.85 per SD; 95% confidence interval [CI]: 0.74 to 0.98; p = 0.027). The unadjusted HR for the lowest tertile of total LAEF compared to the highest tertile was 2.0 (95% CI: 1.43 to 2.79; p < 0.001), and the adjusted HR was 1.47 (95% CI: 1.04 to 2.05; p = 0.031). Addition of total LAEF to known clinical risk factors of CVE and left ventricular mass resulted in an improved predictive accuracy (C statistic of 0.76 vs. 0.73, respectively; p = 0.039).
Conclusions Reduced total LAEF was associated with incident ischemic CVE independent of known cerebrovascular risk factors and incident AF. Assessment of LA function may add further information in stratifying asymptomatic individuals at risk for ischemic stroke.
Supported by National Heart, Lung, and Blood Institute contracts N01-HC-95159 through N01-HC-95166, N01-HC-95168, and R01HL127659; and National Center for Research Resources, National Institutes of Health contracts UL1-RR-024156 and UL1-RR-025005. The views expressed in this paper are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the U.S. Department of Health and Human Services. Dr. Shea has received funding from National Heart, Lung, and Blood Institute. Dr. Gottesman is an Associate Editor for the Journal of Neurology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 18, 2018.
- Revision received January 28, 2019.
- Accepted February 1, 2019.
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