Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating Biomarkers
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 as...
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Wiley
2025-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.036931 |
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| author | 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 Berboso Narayanaswamy Venketasubramanian Boon‐Yeow Tan A. Mark Richards Christopher Chen Lieng‐Hsi Ling |
| author_facet | 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 Berboso Narayanaswamy Venketasubramanian Boon‐Yeow Tan A. Mark Richards Christopher Chen Lieng‐Hsi Ling |
| author_sort | Eugene S. J. Tan |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-632d2b884cf04dd6a4e8c265b0e18d3d |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-632d2b884cf04dd6a4e8c265b0e18d3d2025-08-20T03:47:44ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-04-0114810.1161/JAHA.123.036931Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating BiomarkersEugene S. J. Tan0Saima Hilal1Siew Pang Chan2Ming Ann Sim3Mitchell K. P. Lai4Joyce Chong5Caroline Robert6Hazliza Hazli7Lingli Gong8Josephine Lunaria Berboso9Narayanaswamy Venketasubramanian10Boon‐Yeow Tan11A. Mark Richards12Christopher Chen13Lieng‐Hsi Ling14National University Heart Centre Singapore SingaporeMemory Aging and Cognition Center National University Health System Singapore SingaporeYong Loo Lin School of Medicine National University of Singapore Singapore SingaporeYong Loo Lin School of Medicine National University of Singapore Singapore SingaporeMemory Aging and Cognition Center National University Health System Singapore SingaporeMemory Aging and Cognition Center National University Health System Singapore SingaporeYong Loo Lin School of Medicine National University of Singapore Singapore SingaporeNational University Heart Centre Singapore SingaporeYong Loo Lin School of Medicine National University of Singapore Singapore SingaporeYong Loo Lin School of Medicine National University of Singapore Singapore SingaporeRaffles Neuroscience Centre Singapore SingaporeSt. Luke’s Hospital Singapore SingaporeNational University Heart Centre Singapore SingaporeMemory Aging and Cognition Center National University Health System Singapore SingaporeNational University Heart Centre Singapore SingaporeBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.123.036931atrial fibrosisatrial straincerebrovascular diseasecognitive impairmentdementia |
| spellingShingle | 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 Berboso Narayanaswamy Venketasubramanian Boon‐Yeow Tan A. Mark Richards Christopher Chen Lieng‐Hsi Ling Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating Biomarkers Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrosis atrial strain cerebrovascular disease cognitive impairment dementia |
| title | Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating Biomarkers |
| title_full | Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating Biomarkers |
| title_fullStr | Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating Biomarkers |
| title_full_unstemmed | Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating Biomarkers |
| title_short | Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating Biomarkers |
| title_sort | left atrial myocardial mechanics association with cognitive dysfunction cerebrovascular disease and circulating biomarkers |
| topic | atrial fibrosis atrial strain cerebrovascular disease cognitive impairment dementia |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.036931 |
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