BACKGROUND: Decreased peak atrial longitudinal strain (LA strain) derived from two-dimensional speckle tracking is frequently observed in patients with atrial fibrillation (AF) and associated with the risk of ischemic stroke. OBJECTIVE: We aimed to study the predictive power of the decrease in LA strain in AF population 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. The standard score of LA strain (ZLA) was calculated, and patients were classified into five groups: Z0 (0 to -1), Z-1 (-1 to -2), Z-2 (-2 to -3), Z-3, (-3 to -4), and Z-4 (&#8804;-4). The clinical end point was an ischemic stroke. RESULTS: Among 1,364 subjects with AF (71.4 ± 12.1 years; 55.6%, men), 105 encountered ischemic strokes during a mean follow-up duration 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 [HR], 3.697; 95% confidence interval [CI], 1.966-6.951; p < 0.001) and Z-4 (HR, 6.447; 95% CI, 2.990-13.904; p < 0.001) groups in univariate Cox regression analysis. The results remained consistent after multivariate Cox regression analysis. CONCLUSION: The decrease of LA strain could be applied in a stratified manner and is significantly associated with the risk of stroke independent from baseline covariates.
The Decrease in Peak Atrial Longitudinal Strain in Patients with Atrial Fibrillation as a Practical Parameter for Stroke Risk Stratification