Reduced Left Atrial Rotational Flow Is Independently Associated With Embolic Brain Infarcts.

Autor:	Spartera M; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom. Electronic address: marco.spartera@gmail.com., Stracquadanio A; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom., Pessoa-Amorim G; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom., Harston G; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom., Mazzucco S; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, Oxford, United Kingdom., Young V; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom., Von Ende A; CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom., Hess AT; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom., Ferreira VM; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom., Kennedy J; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom., Neubauer S; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom., Casadei B; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom., Wijesurendra RS; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2023 Sep; Vol. 16 (9), pp. 1149-1159. Date of Electronic Publication: 2023 May 17.
DOI:	10.1016/j.jcmg.2023.03.006
Abstrakt:	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 CHA 2 DS 2 VASc 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 CHA 2 DS 2 VASc = 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, CHA 2 DS 2 VASc 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. Competing Interests: Funding Support and Author Disclosures The study was funded by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and by the British Heart Foundation (BHF). Drs Spartera, Pessoa-Amorim, and Wijesurendra are funded by the NIHR Oxford BRC. Drs Ferreira and Casadei are funded by the BHF. Drs Spartera, Hess, and Wijesurendra have received support from the BHF Centre of Research Excellence, Oxford. Dr Spartera has received support from a competitive scholarship for young cardiologists awarded by the Italian Society of Cardiology and funded via MSD Italia–Merck Sharp and Dohme Corp. Dr Casadei has received support in kind from Roche Diagnostics (blood assays) and iRhythm (ECG monitors) for clinical studies on atrial fibrillation. Dr Wijesurendra has received travel assistance from Abbott. Dr Harston has received funding from Brainomix Limited. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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