Author + information
- Received August 1, 2012
- Revision received September 18, 2012
- Accepted October 1, 2012
- Published online March 1, 2013.
- Cesare Russo, MD⁎,
- Zhezhen Jin, PhD†,
- Rui Liu, MD⁎,
- Shinichi Iwata, MD⁎,
- Aylin Tugcu, MD⁎,
- Mitsuhiro Yoshita, MD, PhD‡,
- Shunichi Homma, MD⁎,
- Mitchell S.V. Elkind, MD, MS§,
- Tatjana Rundek, MD, PhD∥,¶,
- Charles DeCarli, MD#,
- Clinton B. Wright, MD, MS∥,¶,
- Ralph L. Sacco, MD, MS∥,¶,⁎⁎ and
- Marco R. Di Tullio, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Marco R. Di Tullio, Division of Cardiology, Columbia University Medical Center, 630 West 168th Street, PH3-342, New York, New York 10032
Objectives The purpose of this study was to assess the relationship of left atrial (LA) phasic volumes and LA reservoir function with subclinical cerebrovascular disease in a stroke-free community-based cohort.
Background An increase in LA size is associated with cardiovascular events including stroke. However, it is not known whether LA phasic volumes and reservoir function are associated with subclinical cerebrovascular disease.
Methods The LA minimum (LAVmin) and maximum (LAVmax) volumes, and LA reservoir function, measured as total emptying volume (LAEV) and total emptying fraction (LAEF), were assessed by real-time 3-dimensional echocardiography in 455 stroke-free participants from the community-based CABL (Cardiovascular Abnormalities and Brain Lesions) study. Subclinical cerebrovascular disease was assessed as silent brain infarcts (SBI) and white matter hyperintensity volume (WMHV) by brain magnetic resonance imaging.
Results Prevalence of SBI was 15.4%; mean WMHV was 0.66 ± 0.92%. Participants with SBI showed greater LAVmin (17.1 ± 9.3 ml/m2 vs. 12.5 ± 5.6 ml/m2, p < 0.01) and LAVmax (26.6 ± 8.8 ml/m2 vs. 23.3 ± 7.0 ml/m2, p < 0.01) compared to those without SBI. The LAEV (9.5 ± 3.4 ml/m2 vs. 10.8 ± 3.9 ml/m2, p < 0.01) and LAEF (38.7 ± 14.7% vs. 47.0 ± 11.9%, p < 0.01) were also reduced in participants with SBI. In univariate analyses, greater LA volumes and smaller reservoir function were significantly associated with greater WMHV. In multivariate analyses, LAVmin remained significantly associated with SBI (adjusted odds ratio per SD increase: 1.37, 95% confidence interval: 1.04 to 1.80, p < 0.05) and with WMHV (β = 0.12, p < 0.01), whereas LAVmax was not independently associated with either. Smaller LAEF was independently associated with SBI (adjusted odds ratio: 0.67, 95% confidence interval: 0.50 to 0.90, p < 0.01) and WMHV (β = −0.09, p < 0.05).
Conclusions Greater LA volumes and reduced LA reservoir function are associated with subclinical cerebrovascular disease detected by brain magnetic resonance imaging in subjects without history of stroke. In particular, LAVmin and LAEF are more strongly associated with SBI and WMHV than the more commonly measured LAVmax, and their relationship with subclinical brain lesions is independent of other cardiovascular risk factors.
- left atrial volume
- magnetic resonance imaging
- silent brain infarct
- 3-dimensional echocardiography
- white matter hyperintensity volume
This work was supported by the National Institute of Neurological Disorders and Stroke (R01 NS36286 to Dr. Di Tullio and R37 NS29993 to Drs. Sacco and Elkind). Dr. Wright is a consultant to Merck and does stroke adjudication for a clinical trial; and is on the Advisory Board of Nutricia. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 1, 2012.
- Revision received September 18, 2012.
- Accepted October 1, 2012.
- American College of Cardiology Foundation