Reduced Left Atrial Rotational Flow Is Independently Associated With Embolic Brain Infarcts.
JACC Cardiovasc Imaging
; 16(9): 1149-1159, 2023 09.
Article
en En
| MEDLINE
| ID: mdl-37204381
ABSTRACT
BACKGROUND:
Up to 25% of embolic strokes occur in individuals without atrial fibrillation (AF) or other identifiable mechanisms.OBJECTIVES:
This study aims to assess whether left atrial (LA) blood flow characteristics are associated with embolic brain infarcts, independently of AF.METHODS:
The authors recruited 134 patients 44 with a history of ischemic stroke and 90 with no history of stroke but CHA2DS2VASc score ≥1. Cardiac magnetic resonance (CMR) evaluated cardiac function and LA 4-dimensional flow parameters, including velocity and vorticity (a measure of rotational flow), and brain magnetic resonance imaging (MRI) was performed to detect large noncortical or cortical infarcts (LNCCIs) (likely embolic), or nonembolic lacunar infarcts.RESULTS:
Patients (41% female; age 70 ± 9 years) had moderate stroke risk (median CHA2DS2VASc = 3, Q1-Q3 2-4). Sixty-eight (51%) had diagnosed AF, of whom 58 (43%) were in AF during CMR. Thirty-nine (29%) had ≥1 LNCCI, 20 (15%) had ≥1 lacunar infarct without LNCCI, and 75 (56%) had no infarct. Lower LA vorticity was significantly associated with prevalent LNCCIs after adjustment for AF during CMR, history of AF, CHA2DS2VASc score, LA emptying fraction, LA indexed maximum volume, left ventricular ejection fraction, and indexed left ventricular mass (OR 2.06 [95% CI 1.08-3.92 per SD]; P = 0.027). By contrast, LA flow peak velocity was not significantly associated with LNCCIs (P = 0.21). No LA parameter was associated with lacunar infarcts (all P > 0.05).CONCLUSIONS:
Reduced LA flow vorticity is significantly and independently associated with embolic brain infarcts. Imaging LA flow characteristics may aid identification of individuals who would benefit from anticoagulation for embolic stroke prevention, regardless of heart rhythm.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Circulación Sanguínea
/
Infarto Encefálico
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Accidente Cerebrovascular Embólico
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Atrios Cardíacos
Tipo de estudio:
Etiology_studies
/
Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
JACC Cardiovasc Imaging
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
/
DIAGNOSTICO POR IMAGEM
Año:
2023
Tipo del documento:
Article