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Atrial cardiomyopathy is characterized by changes in left atrial (LA) function and size and is associated with adverse cardiovascular events. Decreased (worsened) LA function is associated with poor cardiovascular outcomes in the general population, with worse outcomes in patients with cardiovascular disease. Despite evidence that atrial myopathy is associated with adverse cardiovascular outcomes, little is known about the relationship between atrial myopathy and dementia. In addition, previous studies have found that electrocardiogram (ECG)-marked atrial myopathy is associated with more severe cognitive decline and dementia. However, whether echocardiographically assessed abnormalities in LA function and size are associated with an increased risk of dementia is unclear.
Recently, a study published in the journal JAMA evaluated the relationship between LA function and size and the onset of dementia, let’s take a look.
Methods
Community Arteriosclerosis Risk Study ( ARIC) is a community-based prospective cohort, and this study is an exploratory retrospective analysis based on ARIC.
In this analysis, visit 5 (2011-2013) served as baseline.
Participants who were free of atrial fibrillation and stroke and had two-dimensional echocardiography (2DE) in 2011-2013 were included.
LA function (reservoir strain, conduit strain, contractile strain, emptying fraction, passive emptying fraction, and active emptying fraction) assessed by 2DE, and LA size ( maximum and minimum volume indices). Dementia cases were identified using in-person and telephone cognitive assessments, hospital codes, and death certificates.
Results
A total of 4096 subjects were included (mean age 75 years; 60% female; 22% black),
median follow-up 6 Years later, 531 cases of dementia were diagnosed.
According to different indicators, the incidence of dementia in the lowest LA quintile was:
4.80/100 person-years ( Reserve strain),
3.94/100 person-years (pipeline strain),
3.29/100 person-years (systolic period) strain),
4.20/100 person-years (left atrial emptying fraction),
3.67/100 person-years ( left atrial passive emptying score),
3.27/100 person-years (left atrial active emptying score).
After adjusting for multiple variables, among the LA function indicators,
Except LA passive emptying fraction was not significantly associated with dementia (HR, 1.26 [95%CI, 0.93-1.71]),
reserved strain, pipeline Strain, systolic strain, fractional LA emptying and fractional LA active emptying,
the lowest and highest quintiles were all significantly associated with dementia,< /span>
The hazard ratios (HR) were:
1.98 (95%CI, 1.42-2.75),
1.50 (95%CI, 1.09-2.06),
1.57 (95%CI, 1.16-2.14),
1.87 (95%CI, 1.31-2.65)
1.43 (95%CI, 1.04-1.96).
The highest incidence of dementia in the quintile of the LA largest volume index was 3.18/100 person-years span>
(HR is 0.77 [95%CI, 0.58-1.02] for the highest and lowest quintiles),
LA is the smallest The highest incidence of dementia in the quintile of the volume index was 3.18/100 person-years
(HR 0.95 [95%CI, 0.71- 1.28]).
The results showed that the LA maximum volume index and the minimum volume index were not significantly associated with the risk of dementia, and the sensitivity analysis results were still reliable after excluding subjects with atrial fibrillation and stroke.
Conclusions
Several ultrasound of LA function Abnormal cardiac parameters were significantly associated with increased risk of dementia, while LA size was not significantly associated with dementia risk.
LA size. Impaired LA function may be a risk factor for the development of dementia.
Source:
Association of Echocardiographic Measures of Left Atrial Function and Size With Incident Dementia. JAMA. 2022 Mar 22;327(12):1138-1148. doi: 10.1001/jama.2022.2518
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