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The decrease in peak atrial longitudinal strain in patients with atrial fibrillation as a practical parameter for stroke risk stratification

  • Jo-Nan Liao
    Affiliations
    Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
    Search for articles by this author
  • Tze-Fan Chao
    Affiliations
    Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
    Search for articles by this author
  • Author Footnotes
    1 Drs Hung and Chen contributed equally to this study and are co-corresponding authors.
    Chung-Lieh Hung
    Correspondence
    Address reprint requests and correspondence: Dr Chung-Lieh Hung, Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, Taiwan.
    Footnotes
    1 Drs Hung and Chen contributed equally to this study and are co-corresponding authors.
    Affiliations
    Department of Medicine, MacKay Medical College, New Taipei City, Taiwan

    Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan

    Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

    Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan

    Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan
    Search for articles by this author
  • Author Footnotes
    1 Drs Hung and Chen contributed equally to this study and are co-corresponding authors.
    Shih-Ann Chen
    Correspondence
    Dr Shih-Ann Chen, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan.
    Footnotes
    1 Drs Hung and Chen contributed equally to this study and are co-corresponding authors.
    Affiliations
    Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Cardiovascular Center, Taichung Veterans General Hospital, and Taipei Veterans General Hospital, Taipei, Taiwan
    Search for articles by this author
  • Author Footnotes
    1 Drs Hung and Chen contributed equally to this study and are co-corresponding authors.
Published:December 28, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.12.026

      Background

      Decreased peak atrial longitudinal strain (LA strain) derived from 2-dimensional speckle tracking is frequently observed in patients with atrial fibrillation (AF) and associated with the risk of ischemic stroke.

      Objectives

      We aimed to study the predictive power of the decrease in LA strain in population with AF and hypothesize that the difference in LA strain between reference values could be used in a stratified way for prognostication.

      Methods

      Echocardiography examination was performed using the GE system [GE Vivid i system (GE Healthcare, Horten, Norway)]. The standard score of LA strain (ZLA) was calculated, and patients were classified into 5 groups: Z0 (0 to −1), Z−1 (−1 to −2), Z−2 (−2 to −3), Z−3, (−3 to −4), and Z−4 (≤−4). The clinical end point was an ischemic stroke.

      Results

      Of the 1364 subjects with AF (mean age 71.4 ± 12.1 years; 759 men (55.6%), 105 encountered ischemic strokes during a mean follow-up period of 3.1 ± 1.6 years. No patients in the Z0 and Z−1 groups encountered ischemic stroke. The Kaplan-Meier analysis showed higher rates of stroke in worse ZLA groups. Compared with the Z−2 group, a significantly increased risk of stroke was found in the Z−3 (hazard ratio 3.697; 95% confidence interval 1.966–6.951; P < .001) and Z−4 (hazard ratio 6.447; 95% confidence interval 2.990–13.904; P < .001) groups in univariate Cox regression analysis. The results remained consistent after multivariate Cox regression analysis.

      Conclusion

      The decrease in LA strain could be applied in a stratified manner and is significantly associated with the risk of stroke independent of the baseline covariates.

      Keywords

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