Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating Biomarkers
DOI:
10.1161/jaha.123.036931
Publication Date:
2025-04-08T03:19:48Z
AUTHORS (15)
ABSTRACT
Background
The relationship of left atrial (
LA
) strain with cognition in the absence of
atrial fibrillation
is poorly understood. We investigated the association of
LA
strain with cognitive impairment and its pathogenetic subtype (vascular [
VCI
] or neurodegenerative) and underlying mechanisms via associations with circulating and neuroimaging markers of cerebrovascular disease.
Methods and Results
LA
strain (reservoir, conduit [
LAScd
], contractile) was determined using speckle‐tracking echocardiography in a prospective memory clinic cohort with brain magnetic resonance imaging, neuropsychological assessments, and circulating biomarker measurements. Cognitive impairment was classified as
VCI
or neurodegenerative in the presence or absence of significant cerebrovascular disease, respectively. Among 251 subjects (age 75±8 years, 59% women) without
atrial fibrillation
, 178 (71%) had cognitive impairment (20% mild, 14% moderate, 37% dementia); of these impairments, 58% were
VCI
and 42% neurodegenerative. Only
LAScd
was associated with more severe cognitive impairment (moderate/dementia versus none/mild, adjusted odds ratio
[aOR
] for lowest versus highest tertile >2) and specifically, with worse
Mini‐Mental State Examination
score and memory on neuropsychological testing.
LAScd
was independently associated with
VCI
(versus neurodegenerative;
aOR
for lowest versus highest tertile, 4.22 [95%
CI,
1.59–11.2]) and not with neurodegenerative markers (circulating
pTau
‐181 [phosphorylated tau‐181], isolated lobar cerebral microbleeds). Both
LAScd
and
LA
reservoir
strain
were associated with increased burden of cerebral small vessel disease on magnetic resonance imaging, but only
LAScd
correlated with circulating biomarkers, reflecting inflammation, neurotrophic processes, and neuronal damage.
Conclusions
Reduced
LA
strain was associated with cognitive impairment, primarily of vascular origin, and a higher burden of cerebral small vessel disease.
LAScd
may be a biomarker of
VCI
in at‐risk subjects without
atrial fibrillation
.
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