Key result
Larger left atrial volume and stiffness indices linked to 2-year executive function decline in metabolic syndrome.
Why the study?
Atrial fibrillation is associated with cognitive impairment, but whether subclinical abnormalities in atrial function and substrate impact cognitive function has received limited attention.
Observational (n=510)
Yes
Standardized Mean Difference: -0.13 (95% CI -0.22–-0.03)
Adverse markers of left atrial structure and function are associated with 2-year detrimental executive function-related cognitive changes in adults with metabolic syndrome, suggesting left atrial substrate as a potential risk factor for cognitive decline.
LA enlargement and stiffness may flag executive decline risk in metabolic syndrome; hypothesis-generating and requires prospective validation before any practice change.
Background Atrial fibrillation has been associated with cognitive impairment. Whether subclinical abnormalities in atrial function and substrate predisposing to atrial fibrillation impact cognitive function has received limited attention. Methods We tested associations of echocardiographic markers of atrial structure and function with cognitive functioning and decline among 510 participants with overweight/obesity and metabolic syndrome (mean age [standard deviation] of 64.4 [5.2] years in men and 66.5 [3.9] in women). Left atrial markers (volume index, emptying fraction, strain, function index, and stiffness index) were estimated based on transthoracic echocardiography. General cognitive functioning (Mini-mental examination), verbal ability (verbal fluency test), memory and attention (Digit Span Tests), and processing speed and executive function (Trail-Making Tests A and B) were assessed at baseline and at the two-year follow-up. Multiple linear regression was used to test associations of atrial markers (modeled in standard deviation units) with baseline and two-year changes in cognitive scores adjusting for demographic and health covariates. Results Left atrial structure and function was not associated with cognitive function at baseline. Larger left atrial volume index (standardized β [95% confidence interval] = -0.13 [-0.22, -0.03]), lower peak longitudinal strain (−0.11 [-0.20, -0.01]), and higher stiffness index (−0.18 [-0.28, -0.08) were associated with 2-year worsening in Trail-Making Test A. Strain measurements were also associated with 2-year change in the Controlled Oral Word Association Test. Conclusion Overall, adverse markers of left atrial structure and function were associated with 2-year detrimental executive function-related cognitive changes in a sample of participants at high risk for cardiovascular disease, highlighting left atrial substrate as a potential risk factor for cognitive decline and dementia.
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González-Casanova et al. (2022) conducted an observational in Metabolic syndrome and overweight/obesity (n=510). Left atrial structure and function markers (e.g., LA volume index) vs. Lower values/standard deviation units was evaluated on 2-year change in Trail-Making Test A score (standardized β -0.13, 95% CI -0.22, -0.03). Larger left atrial volume index (standardized β -0.13) and higher stiffness index (-0.18) were associated with 2-year worsening in executive function among adults with metabolic syndrome.
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