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: Eugene S. J. Tan; Saima Hilal; Siew Pang Chan; Ming Ann Sim; Mitchell K. P. Lai; Joyce Chong; Caroline Robert; Hazliza Hazli; Lingli Gong; Josephine Lunaria...; Narayanaswamy Ven...; Boon‐Yeow Tan; A. Mark Richards; Christopher Chen; Lieng‐Hsi Ling
• Keywords: Cognitive Decline

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