What question did this study set out to answer?

October 17, 2022Journal of the American Heart AssociationOpen Access

Left Atrial Function and Arrhythmias in Relation to Small Vessel Disease on Brain MRI: The Multi‐Ethnic Study of Atherosclerosis

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Why the study?

AF is associated with stroke and cognitive decline, but whether early manifestations of left atrial impairment associate with subclinical brain structural changes is unclear.

Are abnormal left atrial structure and function, supraventricular ectopy, and intermittent atrial fibrillation associated with small vessel disease on brain MRI in individuals without prior stroke or TIA?

Population

967 participants in the Multi-Ethnic Study of Atherosclerosis

Comparison

LA structure and function, supraventricular ectopy, and intermittent AF vs normal parameters or no AF

Design

Observational cohort study

Follow-up

Median 17 months

Authors

TAThomas R. AustinPreventive Cardiology PJPaul N. JensenElectrophysiology INIlya M. NasrallahSprint (United States)

Discussion

Member takes

Implication

LA abnormalities and intermittent AF linked to brain SVD markers; hypothesis-generating for early risk identification, pending prospective confirmation.

Key Points

To determine whether early abnormalities in left atrial structure and function, frequent supraventricular ectopy, and intermittent atrial fibrillation are associated with brain magnetic resonance imaging markers of small vessel disease and atrophy.
Evaluated 967 participants (mean age 72 years; 53% women) without a history of stroke or transient ischemic attack enrolled in the Multi-Ethnic Study of Atherosclerosis.
Assessed cardiac structure, reservoir strain, and rhythm abnormalities via 14-day ambulatory electrocardiographic monitoring and speckle tracking echocardiography, followed by brain magnetic resonance imaging a median of 17 months later.
Intermittent atrial fibrillation was associated with lower white matter fractional anisotropy (-0.25 SDs [95% CI, -0.44 to -0.07]) and higher prevalence of cerebral microbleeds (prevalence ratio: 1.42 [95% CI, 1.12-1.79]) compared with no atrial fibrillation.
Left atrial enlargement independently associated with reduced white matter fractional anisotropy and more microbleeds, while reduced left atrial strain associated with greater microbleed prevalence.
A higher burden of premature atrial contractions was significantly associated with reduced total gray matter volume.

Structured PICO

Population

967 participants from the Multi-Ethnic Study of Atherosclerosis without a history of stroke or transient ischemic attack, mean age 72 years, 53% women.

Intervention

Abnormal left atrial structure and function (LA enlargement, reduced LA strain), frequent premature atrial contractions, and intermittent atrial fibrillation

Comparator

Normal left atrial structure/function and no atrial fibrillation

Outcome

Small vessel disease and atrophy on brain magnetic resonance imaging (including white matter fractional anisotropy, microbleeds, and total gray matter volume)surrogate

Early manifestations of left atrial impairment and intermittent atrial fibrillation are associated with subclinical small vessel disease on brain MRI, suggesting a potential mechanism for cognitive decline before overt stroke.

Cite This Study

Austin et al. (2022) studied this question.

synapsesocial.com/papers/6a83c5946eaad3b729ee8396 https://doi.org/10.1161/jaha.122.026460

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

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Implication

LA abnormalities and intermittent AF linked to brain SVD markers; hypothesis-generating for early risk identification, pending prospective confirmation.

Left Atrial Function and Arrhythmias in Relation to Small Vessel Disease on Brain MRI: The Multi‐Ethnic Study of Atherosclerosis

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Left Atrial Function and Arrhythmias in Relation to Small Vessel Disease on Brain MRI: The Multi‐Ethnic Study of Atherosclerosis

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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