The decrease in peak atrial longitudinal strain in patients with atrial fibrillation as a practical parameter for stroke risk stratification

Decreased peak atrial longitudinal strain (LA strain) derived from 2-dimensional speckle tracking is frequently observed in patients with atrial fibrillation (AF) and associated with the risk of ischemic stroke.We aimed to study the predictive power of the decrease in LA strain in population with AF and hypothesize that the difference in LA strain between reference values could be used in a stratified way for prognostication.Echocardiography examination was performed using the GE system [GE Vivid i system (GE Healthcare, Horten, Norway)]. The standard score of LA strain (ZLA) was calculated, and patients were classified into 5 groups: Z0 (0 to -1), Z-1 (-1 to -2), Z-2 (-2 to -3), Z-3, (-3 to -4), and Z-4 (≤-4). The clinical end point was an ischemic stroke.Of the 1364 subjects with AF (mean age 71.4 ± 12.1 years; 759 men (55.6%), 105 encountered ischemic strokes during a mean follow-up period of 3.1 ± 1.6 years. No patients in the Z0 and Z-1 groups encountered ischemic stroke. The Kaplan-Meier analysis showed higher rates of stroke in worse ZLA groups. Compared with the Z-2 group, a significantly increased risk of stroke was found in the Z-3 (hazard ratio 3.697; 95% confidence interval 1.966-6.951; P < .001) and Z-4 (hazard ratio 6.447; 95% confidence interval 2.990-13.904; P < .001) groups in univariate Cox regression analysis. The results remained consistent after multivariate Cox regression analysis.The decrease in LA strain could be applied in a stratified manner and is significantly associated with the risk of stroke independent of the baseline covariates.