Decrease left atrial operate related to greater threat for dementia

March 22, 2022

2 min learn

Disclosures:
Wang experiences no related monetary disclosures. Please see the examine for all different authors’ related monetary disclosures. Prabhakaran experiences receiving grants from NIH and the Company for Healthcare Analysis and High quality, in addition to private charges from UpToDate. Greenland experiences receiving grants from NIH and AHA.


Echocardiographic measures of decrease left atrial operate had been considerably related to an elevated threat of subsequent dementia, consultants reported in JAMA.

“Though the proof linking atrial myopathy to adversarial cardiovascular outcomes is compelling, much less is understood in regards to the affiliation of atrial myopathy with dementia,” Wendy Wang, MPH, a analysis assistant on the College of Minnesota Faculty of Public Well being, and colleagues wrote.

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To evaluate whether or not a correlation exists between left atrial operate and dimension and dementia, Wang and colleagues performed an exploratory, retrospective evaluation of a four-state Atherosclerosis Threat in Communities cohort examine. Contributors with out prevalent atrial fibrillation and stroke and who underwent two-dimensional echocardiograms between 2011 and 2013 (thought of baseline for the examine) had been monitored by Dec. 31, 2019.

A complete of 4,096 members had been included (imply age, 75 years; 60% girls; 22% Black), and over the 6-year median follow-up interval, 531 dementia circumstances had been recognized.

For all left atrial operate measures, the incidence of dementia was highest within the lowest quintile: 4.8, reservoir pressure; 3.94, conduit pressure; 3.29, contractile pressure; 4.2, emptying fraction; 3.67, passive emptying fraction; and three.27, lively emptying fraction per 100 person-years.

Following full-model changes, there have been important associations between the very best and lowest quintiles for measures of left atrial operate and dementia, together with reservoir pressure (HR = 1.98; 95% CI, 1.42-2.75), conduit pressure (HR = 1.5; 95% CI, 1.09-2.06), contractile pressure (HR = 1.57; 95% CI, 1.16-2.14), emptying fraction (HR = 1.87; 95% CI, 1.31-2.65) and lively emptying fraction (HR = 1.43; 95% CI, 1.04-1.96). Passive emptying fraction was not related to dementia, the authors famous (HR = 1.26; 95% CI, 0.93-1.71).

Left atrial dimension was not considerably related to incident dementia, after full-model adjustment evaluating the very best and lowest quintiles of maximal left atrial quantity index (HR = 0.77; 95% CI, 0.58-1.02) and minimal quantity index (HR = 0.95; 95% CI, 0.71-1.28).

Dementia incidence for the very best maximal quantity index quintile was 3.18 per 100 person-years and three.5 per 100 person-years for the very best minimal quantity index. Each measures weren’t related to dementia.

“To our information, that is the primary examine to report an impartial affiliation between echocardiographic measures of [left atrial] operate with dementia,” the authors wrote. “By interrogating a complete set of [left atrial] operate measures — quantified by speckle monitoring and volumetric evaluation — this examine advances the sphere by linking [left atrial] operate measures to dementia threat for the primary time.”

In associated editorial, Shyam Prabhakaran, MD, MS, of the division of neurology on the College of Chicago, and Philip Greenland, MD, of the division of preventative medication at Northwestern College, state that Wang and colleagues’ examine “introduces some attention-grabbing ideas concerning the mechanisms by which atrial myopathy, nonetheless outlined, could contribute to dementia threat.”

Prabhakaran and Greenland wrote that though Wang and colleagues used echocardiographic measures, there are extra superior imaging instruments accessible to evaluate left atrial move patterns and areas of atrial blood stasis.

“Given the exploratory nature of the examine findings, potential validation in different cohorts is clearly vital,” Prabhakaran and Greenland wrote. “Along with identification of the exact biomarkers of atrial myopathy, randomized medical trials testing remedies in sufferers with atrial myopathy might additional set up a causal impact on dementia.”

References:

Prabhakaran S, Greenland P. JAMA. 2022;doi:10.1001/jama.2022.2374.

Wang W, et al. JAMA. 2022;doi:10.1001/jama.2022.2518.

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