Masini Gabriele, Wang Wendy, Ji Yuekai, Eaton Anne, Inciardi Riccardo M, Soliman Elsayed Z, Passman Rod S, Solomon Scott D, Shah Amil M, De Caterina Raffaele, Chen Lin Yee
Pisa University Hospital, Cardiology Division, University of Pisa, Italy (G.M., R.D.C.).
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (W.W.).
Stroke. 2025 Apr;56(4):858-867. doi: 10.1161/STROKEAHA.124.047747. Epub 2025 Mar 7.
Various measures of abnormal left atrial (LA) structure or function (LA myopathy) are associated with a higher risk of ischemic stroke and dementia, independent of atrial fibrillation. However, limited data exist on their prognostic usefulness. Therefore, we aimed to assess the ability of markers of LA myopathy to improve the prediction of ischemic stroke and dementia.
The ARIC study (Atherosclerosis Risk in Communities) is a prospective community-based cohort study. For this analysis, we included participants who attended visit 5 (2011-2013) without a history of stroke or atrial fibrillation and had a 12-lead ECG and a transthoracic echocardiogram. Markers of LA myopathy included P wave abnormalities from 12-lead ECG, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and LA volume and strain parameters from the echocardiogram. The primary composite outcome comprised ischemic stroke and dementia, which were ascertained through hospital surveillance, cohort follow-up, and death registries. To determine improvement in risk prediction of the composite outcome, each marker was individually added to a model that included CHADS-VASc variables, and Akaike information criterion, C statistic, and its change were computed. Cox proportional hazards models were used to assess the independent association of LA myopathy markers with the outcome.
Among 4712 participants (59% female; mean age, 74 years), 193 ischemic strokes and 769 dementia cases were ascertained over a median follow-up of 8.3 years. Of LA myopathy markers, only LA reservoir strain and NT-proBNP significantly improved C statistic when added to the CHADS-VASc model (base C statistic, 0.677) for the prediction of the composite outcome. Adding the LA reservoir yielded the highest increase in C statistic (0.010 [95% CI, 0.003-0.017]), and the model including the LA reservoir showed the lowest Akaike information criterion. In multivariable regression models, LA volume index, NT-proBNP, and LA strain parameters were significantly associated with the composite outcome.
Of various LA myopathy markers, LA reservoir yields the greatest improvement in the prediction of ischemic stroke and dementia, supporting its use to identify people at high risk of cerebrovascular events and dementia.
左心房（LA）结构或功能异常（LA肌病）的各种指标与缺血性中风和痴呆的较高风险相关，且独立于房颤。然而，关于它们的预后效用的数据有限。因此，我们旨在评估LA肌病标志物改善缺血性中风和痴呆预测的能力。
ARIC研究（社区动脉粥样硬化风险研究）是一项基于社区的前瞻性队列研究。对于本分析，我们纳入了在第5次随访（2011 - 2013年）时无中风或房颤病史且有12导联心电图和经胸超声心动图检查的参与者。LA肌病标志物包括12导联心电图的P波异常、NT - proBNP（N末端前B型利钠肽）以及超声心动图的LA容积和应变参数。主要复合结局包括缺血性中风和痴呆，通过医院监测、队列随访和死亡登记确定。为了确定复合结局风险预测的改善情况，将每个标志物单独添加到一个包含CHADS - VASc变量的模型中，并计算赤池信息准则、C统计量及其变化。使用Cox比例风险模型评估LA肌病标志物与结局的独立关联。
在4712名参与者（59%为女性；平均年龄74岁）中，在中位随访8.3年期间确定了193例缺血性中风和769例痴呆病例。在LA肌病标志物中，当添加到CHADS - VASc模型（基础C统计量为0.677）中用于预测复合结局时，只有LA储备应变和NT - proBNP显著改善了C统计量。添加LA储备导致C统计量增加最多（0.010 [95%CI，0.003 - 0.017]），并且包含LA储备的模型显示赤池信息准则最低。在多变量回归模型中，LA容积指数、NT - proBNP和LA应变参数与复合结局显著相关。
在各种LA肌病标志物中，LA储备在缺血性中风和痴呆的预测中改善最大，支持其用于识别脑血管事件和痴呆的高危人群。
