Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS

Francesco Bianco; Raffaele De Caterina; Alvin Chandra; Iolanda Aquila; Brian Claggett; Michelle C. Johansen; Alexandra Gonçalves; Faye L. Norby; Rebecca Cogswell; Elsayed Z. Soliman; Rebecca Gottesman; Thomas Mosley; Alvaro Alonso; Amil Shah; Scott D. Solomon; Lin Yee Chen

doi:10.1161/JAHA.121.024292

Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS

Francesco Bianco, Raffaele De Caterina, Alvin Chandra, Iolanda Aquila, Brian Claggett, Michelle C. Johansen, Alexandra Gonçalves, Faye L. Norby, Rebecca Cogswell, Elsayed Z. Soliman, Rebecca Gottesman, Thomas Mosley, Alvaro Alonso, Amil Shah, Scott D. Solomon, Lin Yee Chen

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

BACKGROUND: Age-related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3-dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. METHODS AND RESULTS: We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3-dimensional echocardio-graphic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging– detectable infarcts (n=315), magnetic resonance imaging– diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain—a 3-dimensional echocardiographic index of LA reservoir function—and E/e’ divided by LA global longitudinal strain—an index of LA stiffness—worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e’ divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. CONCLUSIONS: In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age-related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke.

Original language	English (US)
Article number	e024292
Journal	Journal of the American Heart Association
Volume	11
Issue number	9
DOIs	https://doi.org/10.1161/JAHA.121.024292
State	Published - May 3 2022

Bibliographical note

Funding Information:
The ARIC study is performed as a collaborative investigation supported by National Heart, Lung, and Blood Institute contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C. Neurocognitive data are collected by U01 HL096812, HL096814, HL096899, HL096902, and HL096917 with previous brain MRI examinations funded by R01-HL70825. Dr Chen is supported by R01 HL126637, R01 HL141288, RF1 NS127266, R01 HL158022, and K24 HL155813.

Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Keywords

3-dimensional echocardiography
left atrial function
left atrial stiffness
left atrial strain
subclinical cerebral infarctions

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1161/JAHA.121.024292

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Bianco, F., De Caterina, R., Chandra, A., Aquila, I., Claggett, B., Johansen, M. C., Gonçalves, A., Norby, F. L., Cogswell, R., Soliman, E. Z., Gottesman, R., Mosley, T., Alonso, A., Shah, A., Solomon, S. D., & Chen, L. Y. (2022). Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS. Journal of the American Heart Association, 11(9), Article e024292. https://doi.org/10.1161/JAHA.121.024292

Bianco, F, De Caterina, R, Chandra, A, Aquila, I, Claggett, B, Johansen, MC, Gonçalves, A, Norby, FL , Cogswell, R, Soliman, EZ, Gottesman, R, Mosley, T, Alonso, A, Shah, A, Solomon, SD & Chen, LY 2022, 'Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS', Journal of the American Heart Association, vol. 11, no. 9, e024292. https://doi.org/10.1161/JAHA.121.024292

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title = "Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS",

abstract = "BACKGROUND: Age-related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3-dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. METHODS AND RESULTS: We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3-dimensional echocardio-graphic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging– detectable infarcts (n=315), magnetic resonance imaging– diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain—a 3-dimensional echocardiographic index of LA reservoir function—and E/e{\textquoteright} divided by LA global longitudinal strain—an index of LA stiffness—worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e{\textquoteright} divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. CONCLUSIONS: In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age-related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke.",

keywords = "3-dimensional echocardiography, left atrial function, left atrial stiffness, left atrial strain, subclinical cerebral infarctions",

author = "Francesco Bianco and {De Caterina}, Raffaele and Alvin Chandra and Iolanda Aquila and Brian Claggett and Johansen, {Michelle C.} and Alexandra Gon{\c c}alves and Norby, {Faye L.} and Rebecca Cogswell and Soliman, {Elsayed Z.} and Rebecca Gottesman and Thomas Mosley and Alvaro Alonso and Amil Shah and Solomon, {Scott D.} and Chen, {Lin Yee}",

note = "Funding Information: The ARIC study is performed as a collaborative investigation supported by National Heart, Lung, and Blood Institute contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C. Neurocognitive data are collected by U01 HL096812, HL096814, HL096899, HL096902, and HL096917 with previous brain MRI examinations funded by R01-HL70825. Dr Chen is supported by R01 HL126637, R01 HL141288, RF1 NS127266, R01 HL158022, and K24 HL155813. Publisher Copyright: {\textcopyright} 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",

year = "2022",

month = may,

day = "3",

doi = "10.1161/JAHA.121.024292",

language = "English (US)",

volume = "11",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "American Heart Association Inc.",

number = "9",

}

TY - JOUR

T1 - Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction

T2 - ARIC-NCS

AU - Bianco, Francesco

AU - De Caterina, Raffaele

AU - Chandra, Alvin

AU - Aquila, Iolanda

AU - Claggett, Brian

AU - Johansen, Michelle C.

AU - Gonçalves, Alexandra

AU - Norby, Faye L.

AU - Cogswell, Rebecca

AU - Soliman, Elsayed Z.

AU - Gottesman, Rebecca

AU - Mosley, Thomas

AU - Alonso, Alvaro

AU - Shah, Amil

AU - Solomon, Scott D.

AU - Chen, Lin Yee

N1 - Funding Information: The ARIC study is performed as a collaborative investigation supported by National Heart, Lung, and Blood Institute contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C. Neurocognitive data are collected by U01 HL096812, HL096814, HL096899, HL096902, and HL096917 with previous brain MRI examinations funded by R01-HL70825. Dr Chen is supported by R01 HL126637, R01 HL141288, RF1 NS127266, R01 HL158022, and K24 HL155813. Publisher Copyright: © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

PY - 2022/5/3

Y1 - 2022/5/3

N2 - BACKGROUND: Age-related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3-dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. METHODS AND RESULTS: We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3-dimensional echocardio-graphic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging– detectable infarcts (n=315), magnetic resonance imaging– diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain—a 3-dimensional echocardiographic index of LA reservoir function—and E/e’ divided by LA global longitudinal strain—an index of LA stiffness—worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e’ divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. CONCLUSIONS: In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age-related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke.

AB - BACKGROUND: Age-related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3-dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. METHODS AND RESULTS: We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3-dimensional echocardio-graphic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging– detectable infarcts (n=315), magnetic resonance imaging– diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain—a 3-dimensional echocardiographic index of LA reservoir function—and E/e’ divided by LA global longitudinal strain—an index of LA stiffness—worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e’ divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. CONCLUSIONS: In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age-related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke.

KW - 3-dimensional echocardiography

KW - left atrial function

KW - left atrial stiffness

KW - left atrial strain

KW - subclinical cerebral infarctions

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UR - http://www.scopus.com/inward/citedby.url?scp=85129781782&partnerID=8YFLogxK

U2 - 10.1161/JAHA.121.024292

DO - 10.1161/JAHA.121.024292

M3 - Article

C2 - 35491988

AN - SCOPUS:85129781782

SN - 2047-9980

VL - 11

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 9

M1 - e024292

ER -

Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS

Abstract

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