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September 17, 2026Journal of Cardiovascular ImagingOpen Access

Higher CHA2DS2-VASc scores are linked to decreased LA strain, mediated by LV diastolic dysfunction.

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Why the study?

Is the CHA2DS2-VASc score associated with left atrial strain impairment in patients in sinus rhythm?

Population

150 patients in sinus rhythm

Design

Editorial

Key result

Higher CHA2DS2-VASc scores were associated with progressively decreased left atrial reservoir and conduit strain in patients in sinus rhythm, largely mediated by left ventricular diastolic dysfunction.

Authors

YCYu Jin ChungJHJiwon Hwang

Discussion

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Overview

Should not change practice in sinus-rhythm patients; extends observational links between CHA2DS2-VASc and subclinical LA dysfunction via LVDD.

Key Points

  • To assess the association between cardiovascular risk categorized by the CHA₂DS₂-VASc score and left atrial strain, evaluating left ventricular diastolic dysfunction as a potential mediator.
  • Analyzed speckle-tracking echocardiographic measurements of left atrial strain in a cohort of 150 patients in sinus rhythm.
  • Conducted mediation analysis to quantify the direct and indirect pathways linking the CHA₂DS₂-VASc score to left atrial reservoir and conduit strain via left ventricular diastolic dysfunction.
  • Left atrial reservoir and conduit strain decreased progressively across higher CHA₂DS₂-VASc risk strata, whereas left atrial volume index showed no significant variation between groups.
  • Mediation analysis revealed that the impairment in left atrial conduit strain was predominantly mediated by left ventricular diastolic dysfunction, whereas reservoir strain preserved an independent direct association with cardiovascular risk.

Structured PICO

Is the CHA2DS2-VASc score associated with left atrial strain impairment in patients in sinus rhythm?

P
Population
150 patients in sinus rhythm assessed for the association between the CHA2DS2-VASc score and left atrial function.
E
Exposure
CHA2DS2-VASc score risk categorization
O
Outcome
Left atrial function (reservoir and conduit strain) assessed by speckle-tracking echocardiographysurrogate

In patients in sinus rhythm, higher CHA2DS2-VASc scores are associated with subclinical left atrial dysfunction, which is largely mediated by left ventricular diastolic dysfunction.

Limitations

  • Lack of longitudinal data to determine the prognostic significance of subclinical LA dysfunction
  • Need for longitudinal studies to determine prognostic significance

Cite This Study

Chung et al. (2026) conducted an editorial in Sinus rhythm (n=150). CHA2DS2-VASc score was evaluated on Left atrial reservoir and conduit strain. Higher CHA2DS2-VASc scores were associated with progressively decreased left atrial reservoir and conduit strain in patients in sinus rhythm, largely mediated by left ventricular diastolic dysfunction.

synapsesocial.com/papers/6aabb8495f706d05830e7f07https://doi.org/10.1186/s44348-026-00097-2
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