Left Atrial Strain Provides Incremental Value for Embolism Risk Stratification over CHA2DS2-VASc Score and Indicates Prognostic Impact in Patients with Atrial Fibrillation

Background The aim of this study was to investigate whether left atrial (LA) strain has incremental value over the CHA 2 DS 2 -VASc score for stratifying the risk for embolism in patients with atrial fibrillation (AF) and whether LA strain predicts poststroke mortality. Methods Consecutive patients with paroxysmal or persistent AF with acute embolism (82 patients) or without (204 controls) were prospectively enrolled. Global peak LA longitudinal strain during ventricular systole (LA S ) was assessed during AF rhythm. Global LA S was compared between the groups in the first cross-sectional study. Then, the 82 patients with acute embolism were prospectively followed during the second prospective cohort study. Results Global LA S was lower in patients with acute embolism than in controls ( P S P S was independently associated with acute embolism (odds ratio, 0.74; 95% confidence interval, 0.67–0.82; P 2 DS 2 -VASc score ( P S independently predicted mortality after embolism. Conclusions In this observational study, LA strain provided incremental diagnostic information over that provided by the CHA 2 DS 2 -VASc score, suggesting that LA strain analysis could improve the current risk stratification of embolism in patients with AF. LA strain can also predict poststroke mortality.