Relation of left atrial dysfunction to ischemic stroke in patients with coronary heart disease (from the heart and soul study)

Am J Cardiol. 2014 May 15;113(10):1679-84. doi: 10.1016/j.amjcard.2014.02.021. Epub 2014 Mar 3.

Abstract

This study sought to determine whether left atrial (LA) dysfunction independently predicts ischemic stroke. Atrial fibrillation (AF) impairs LA function and is associated with ischemic stroke. However, ischemic stroke frequently occurs in patients without known AF. The direct relation between LA function and risk of ischemic stroke is unknown. We performed transthoracic echocardiography at rest in 983 subjects with stable coronary heart disease. To quantify LA dysfunction, we used the left atrial function index (LAFI), a validated formula incorporating LA volumes at end-atrial systole and diastole. Cox proportional hazards models were used to evaluate the association between LAFI and ischemic stroke or transient ischemic attack (TIA). Over a mean follow-up of 7.1 years, 58 study participants (5.9%) experienced an ischemic stroke or TIA. In patients without known baseline AF or warfarin therapy (n = 893), participants in the lowest quintile of LAFI had >3 times the risk of ischemic stroke or TIA (hazard ratio 3.3, 95% confidence interval 1.1 to 9.7, p = 0.03) compared with those in the highest quintile. For each standard deviation (18.8 U) decrease in LAFI, the hazard of ischemic stroke or TIA increased by 50% (hazard ratio 1.5, 95% confidence interval 1.0 to 2.1, p = 0.04). Among measured echocardiographic indexes of LA function, including LA volume, LAFI was the strongest predictor of ischemic stroke or TIA. In conclusion, LA dysfunction is an independent risk factor for stroke or TIA, even in patients without baseline AF.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Function, Left / physiology*
  • Brain Ischemia / diagnosis
  • Brain Ischemia / epidemiology
  • Brain Ischemia / etiology*
  • California / epidemiology
  • Coronary Disease / complications*
  • Coronary Disease / diagnosis
  • Coronary Disease / physiopathology
  • Echocardiography
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Heart Atria / diagnostic imaging
  • Heart Atria / physiopathology*
  • Humans
  • Incidence
  • Male
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Time Factors