LAUSR

BACKGROUND Decreased peak atrial longitudinal strain (LA strain) derived from two-dimensional speckle tracking is frequently observed in patients with atrial fibrillation (AF) and associated with the risk of ischemic stroke. OBJECTIVE We aimed to study the predictive power of the decrease in LA strain in AF population and hypothesize that the difference in LA strain between reference values could be used in a stratified way for prognostication. METHODS Echocardiography examination was performed using the GE system. The standard score of LA strain (ZLA) was calculated, and patients were classified into five 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. RESULTS Among 1,364 subjects with AF (71.4 ± 12.1 years; 55.6%, men), 105 encountered ischemic strokes during a mean follow-up duration 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 [HR], 3.697; 95% confidence interval [CI], 1.966-6.951; p < 0.001) and Z-4 (HR, 6.447; 95% CI, 2.990-13.904; p < 0.001) groups in univariate Cox regression analysis. The results remained consistent after multivariate Cox regression analysis. CONCLUSION The decrease of LA strain could be applied in a stratified manner and is significantly associated with the risk of stroke independent from baseline covariates.