Left Atrial Deformation And Risk of Transient Ischemic Attack And Stroke In Paroxysmal Atrial Fibrillation

Left atrial (LA) remodeling is closely related to cerebral stroke, but the relationship between impaired deformability of LA in early stages and stroke/TIA is not clear. The aim of this study was to evaluate the changes of LA deformability and its relationship with stroke/TIA events by using Speckle Tracking echocardiography. In 365 patients with paroxysmal atrial fibrillation (AF) (318, Non stroke/TIA; 47, stroke/TIA), comprehensive echocardiography was performed by using speckle tracking imaging to calculate mean LA longitudinal strain and strain rate values from apical four chamber view, apical two chamber view and apical three cavity view. The patients in stroke/TIA group had greater ages, a greater proportion of men and lower LA strain rate during left ventricular (LV) early diastole (SRE), and the difference was statistically significant( p <0.05). In the univariate linear regression analysis, the following clinical and conventional echocardiographic parameters each had a significant linear correlation with SRE( p <0.001), they were E/A ratio, LA volume index, body mass index, mean E/e′, LV ejection fraction, age, proportion of hypertension. Through a multiple linear regression analysis, the results show that there is a linear dependence between SRE and E/A ratio, LA volume index and Body mass index. The regression equation is y=-1.430-0.394X1+0.012X2+0.019X3(p<0.001) (y,SRE; X1,E/A ratio; X2,LA volume index; X3,Body mass index).In the multivariate logistic regression analyses, SRE and Sex ratio were independently risk factors stroke/TIA. (SRE, OR 2.945, 95% CI 1.092-7.943, p = 0.033; Sex, OR 0.462, 95% CI 0.230-0.930, p = 0.031)In patients with paroxysmal AF, SRE could reflect the impaired deformability of LA in early stages, and it was associated with the risk of stroke/TIA.