Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS(2) scores.

Background: Left atrial (LA) strain as a marker for discrimination of risk for stroke and transient ischemic attack (TIA) in patients with atrial fibrillation and low-risk CHADS(2) scores (≤1) has yet to be examined.

Methods: Patients with atrial fibrillation, stroke or TIA, and CHADS(2) scores ≤ 1 before their events were identified retrospectively from a large single-center stroke registry and compared with age-matched and gender-matched controls. Antihypertensive use and echocardiographic parameters including chamber volumes and left ventricular mass and LA peak negative and positive strain and strain rate were compared between groups.

Results: Fifty-seven patients meeting entry criteria were identified. Patients demonstrated significantly lower left ventricular ejection fractions, larger LA dimensions, and larger LA volume indexes (24.4 ± 11.9 vs 32.3 ± 13.3 mL/m(2), P = .012) compared with controls. Both peak negative LA strain (-3.2 ± 1.2% vs -6.9 ± 4.2%, P < .001) and peak positive LA strain (14 ± 11% vs 25 ± 12%, P < .001) were significantly reduced in patients compared with controls. Peak negative LA strain was significantly associated with stroke by binary logistic regression (odds ratio, 2.15; P < .001).

Conclusions: In patients with low-risk CHADS(2) scores, atrial fibrillation, and stroke or TIA, reduced LA strain is a potentially sensitive maker for increased risk for stroke or TIA. These results suggest that LA strain may have potential as a tool for helping guide the decision for or against oral anticoagulation in this group of patients.