Quantitative tissue-tracking cardiac magnetic resonance (CMR) of left atrial deformation and the risk of stroke in patients with atrial fibrillation

Background-recent evidence suggests that left atrial (la) dysfunction may be mechanistically contributing to cerebrovascular events in patients with atrial fibrillation (af). we investigated the association between regional la function and a prior history of stroke during sinus rhythm in patients referred for catheter ablation of af. methods and results-a total of 169 patients (59±10 years,74% male,29% persistent af) with a history of af in sinus rhythm at the time of pre-ablation cardiac magnetic resonance (cmr) were analyzed. the la volume,emptying fraction,strain (s),and strain rate (sr) were assessed by tissue-tracking cardiac magnetic resonance. the patients with a history of stroke or transient ischemic attack (n=18) had greater la volumes (vmax and vmin; p=0.02 and p<0.001,respectively),lower la total emptying fraction (p<0.001),lower la maximum and pre-atrial contraction strains (smax and sprea; p<0.001 and p=0.01,respectively),and lower absolute values of la sr during left ventricular (lv) systole and early diastole (srs and sre; p=0.005 and 0.03,respectively) than those without stroke/transient ischemic attack (n=151). multivariable analysis demonstrated that the la reservoir function,including total emptying fraction,smax,and srs,was associated with stroke/transient ischemic attack (odds ratio 0.94,0.91,and 0.17; p=0.03,0.02,and 0.04,respectively) after adjusting for the cha2ds2-vasc score and la vmin. conclusions-depressed la reservoir function assessed by tissue-tracking cardiac magnetic resonance is significantly associated with a prior history of stroke/transient ischemic attack in patients with af. our findings suggest that assessment of la reservoir function can improve the risk stratification of cerebrovascular events in af patients. © 2015 the authors.