Left ventricular diastolic dysfunction is associated with atrial remodeling and risk or presence of stroke in patients with paroxysmal atrial fibrillation

BackgroundAlthough the degree of electroanatomical remodeling of the left atrium (LA) is influenced by left ventricular (LV) diastolic function, clinical implications of estimated LV filling pressure (E/Em) are limited in patients with atrial fibrillation (AF). We hypothesized that increased E/Em is related to an advanced LA remodeling, a high CHA2DS2-VASc score, and the presence of stroke or transient ischemic attack (TIA) in patients with paroxysmal AF.MethodsWe included 1098 patients with paroxysmal AF (male 74.5%, 57.6 ± 11.3 years old) who underwent AF catheter ablation. We compared E/Em to clinical parameters, echocardiography, and three-dimensional-computed tomography findings.ResultsThe E/Em > 15 group (n = 98) was older (p < 0.001) and had more females (p < 0.001), greater LA volume index (p < 0.001), higher CHA2DS2-VASc score (p < 0.001), and stroke/TIA prevalence (p = 0.001) than groups with an E/Em of 8–15 (n = 676) or <8 (n = 324). An E/Em was independently associated with the presence of stroke/TIA (OR 1.638, 95% CI 1.050–2.554, p = 0.030) after adjusting for age, sex, body surface area, LA volume index, and LA appendage volume index.ConclusionsIn patients with paroxysmal AF, the elevated LV filling pressure estimated by E/Em is independently associated with the presence of stroke or TIA.