Key result
Among ischemic stroke patients with a normal left atrial diameter (≤4 cm), a 1 mm increase in diameter was associated with 1.20 times greater odds of scoring high on a cognitive screener.
Why the study?
Whether an association exists between cardiac structural markers, such as LAD and LVEF, and post-ischemic stroke cognition is not yet established.
Does left atrial diameter or left ventricular ejection fraction associate with cognitive performance in ischemic stroke patients?
Cohort (n=108)
No
Does left atrial diameter or left ventricular ejection fraction associate with cognitive performance in ischemic stroke patients?
Effect estimate: OR 1.20 (95% CI 1.05-1.38)
In ischemic stroke patients with normal left atrial size, a larger left atrial diameter is paradoxically associated with better cognitive performance, highlighting a complex relationship between cardiac structure and post-stroke cognition.
Larger left atrial diameter was associated with better cognition in normal-sized atria; hypothesis-generating for cardiac-cognitive links post-stroke.
Background: Cardiac structure is an important determinant of ischemic stroke (IS) etiology; however, whether an association between cardiac structural markers and cognition post-IS exists is not yet established. The aim of this study is to examine the association between LAD and LVEF with cognitive performance among IS patients. Methods: IS patients admitted to the Johns Hopkins Hospital (2017-2019) underwent transthoracic echocardiography. IS was classified (TOAST) by a masked reviewer. Left atrial diameter (LAD) was evaluated as a non-linear continuous variable with one spline knot at 4 cm; left ventricle ejection fraction (LVEF) was dichotomized, then further evaluated as a non-linear continuous variable with spline knots at 50% and 70%. Patients were contacted by telephone on average 422 days post-stroke and administered the Six-Item Screener (SIS) to assess for dementia. SIS scores were dichotomized into low and high, imputing low scores for non-answerers. Multivariable logistic regression determined the association of SIS category with LAD or LVEF. A sensitivity analysis re-evaluated the association between SIS category and LAD, excluding participants with atrial fibrillation (AF). Results: = 108) were on average 61 years old (range = 18-89 years), 55% male, and 63% Black. Among patients considered to have a normal LAD (≤ 4 cm), a 1 mm larger LAD was associated with 1.20 greater odds (95%CI = 1.05-1.38) of scoring in the high SIS category in the final adjustment model. This association remained significant when excluding participants with prevalent AF. There was no association between a 1 mm larger LAD and SIS category among patients with a LAD >4 cm in both the primary analysis and the sensitivity analysis. There was no association between LVEF and SIS category. Conclusions: In this prospective study, among ischemic stroke patients with a LAD within the normal range, a 1 mm increase in LAD was associated with higher scores on a telephone cognitive battery, without an association found among those with a LAD >4 cm.
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Gootee et al. (2022) conducted a cohort in Ischemic stroke (n=108). Left atrial diameter (LAD) was evaluated on High score (4-6) on the Six-Item Screener (SIS) (OR 1.20, 95% CI 1.05-1.38). Among ischemic stroke patients with a normal left atrial diameter (≤4 cm), a 1 mm increase in diameter was associated with 1.20 times greater odds of scoring high on a cognitive screener.
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