Key result
Left atrial mechanical dispersion linked to ~29% higher odds of prior stroke or TIA in AF.
Why the study?
Left atrial mechanical dysfunction is associated with stroke in AF, whereas the contribution of the right atrium to stroke mechanisms had been overlooked.
Does speckle-tracking echocardiography assessment of left and right atrial mechanical function (reservoir strain and mechanical dispersion) identify history of stroke or transient ischemic attack in patients with atrial fibrillation?
Observational (n=422)
Does speckle-tracking echocardiography assessment of left and right atrial mechanical function (reservoir strain and mechanical dispersion) identify history of stroke or transient ischemic attack in patients with atrial fibrillation?
In patients with atrial fibrillation, left atrial mechanical dispersion assessed via speckle-tracking echocardiography is independently associated with prior stroke or TIA and provides superior discriminative ability compared to left or right atrial reservoir strain.
Left atrial mechanical dispersion may refine AF stroke risk stratification; leaves open prospective validation for incident events before clinical use.
Background Left atrial (LA) mechanical dysfunction have been shown to be associated to strokes in atrial fibrillation(AF). However, the contribution of right atrium(RA) in the mechanism of strokes have been overlooked. Accordingly, we aimed to investigate and compare the association of LA and RA mechanics with AF-related stroke. Methods A total of 422 consecutive patients with AF (median age 64 years, 68% male, 46% persistent AF) who underwent echocardiography before catheter ablation were prospectively included. Speckle-tracking echocardiography was used to measure LA reservoir strain(LASr), RA reservoir strain(RASr)and mechanical dispersion (MD) of LA and RA were measured in all patients. Mechanical dispersion was defined as the standard deviation of the time to peak positive strain corrected by R-R interval. Results Patients with a history of stroke or transient ischemic attack (TIA) (n = 53) showed significantly lower LA and RA reservoir strain, and significantly higher LA MD than those without (n=369) (LASr,13.8±6.7% vs.18.2±9.9%, RASr,19.1±10.4% vs.24.3±12.5%, LA MD,10.6±3.6% vs 7.6±3.1%; P < 0.01).However, the RA MD was not significantly different between two groups. LA MD was independently associated with stroke/TIA in five multivariate models (Odds ratio, 1.29-1.34, respectively, P<0.01). In contrast, LASr, RASr and RA MD failed to be independent contributors for identifying strokes. LA MD> 7.77% identified patients with AF-related stroke with a sensitivity of 83% and a specificity of 52.6%,with an AUC of 0.73(P <0.01), which is significantly higher than LASr (AUC 0.63) and RASr (AUC 0.63)(P< 0.01). Conclusions Both left and right atrial mechanical function assessed with speckle tracking echocardiography were more severely impaired in AF patients with a prior stroke or TIA. However, only LA mechanical dispersion was independently associated with stroke/TIA in AF patients, superior to LASr and RA mechanical parameters.ROC curvesstrain analysis
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Mao et al. (2026) conducted an observational in Atrial fibrillation (n=422). Left atrial mechanical dispersion (LA MD) and LA/RA reservoir strain vs. Right atrial mechanical parameters and patients without history of stroke/TIA was evaluated on History of stroke or transient ischemic attack (TIA) (OR 1.29-1.34, p=<0.01). Left atrial mechanical dispersion was independently associated with prior stroke/TIA in AF patients (OR 1.29-1.34, P<0.01; AUC 0.73), outperforming LA and RA reservoir strain (AUC 0.63).
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