Association of Left Atrial Echo Measures With Incident Dementia

Mar 22, 2022
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Authors:
Wang W, Zhang MJ, Inciari RM, et al.
Citation:
Association of Echocardiographic Measures of Left Atrial Function and Size With Incident Dementia. JAMA 2022;237:1138-1148.
Summary By:
Mollie McDermott, MD, MS

Quick Takes

  • The investigators of this large prospective cohort study found that impaired left atrial function as assessed by echocardiogram is associated with an increased risk of incident dementia, independent of the presence of incident atrial fibrillation.
  • The results of this exploratory study add to the growing body of literature that supports a fascinating and likely complex relationship between heart function and brain health.

Study Questions:

Is left atrial (LA) myopathy associated with an increased risk of incident dementia?

Methods:

This is a prospective cohort study of United States participants (aged 45-64 years at enrollment) who were free of dementia, atrial fibrillation (AF), and stroke at baseline. Several measures of LA size and function were derived from each subject’s baseline echocardiogram. Subjects were followed longitudinally. The outcome of interest was incident dementia. Mediation analysis was used to quantify the extent to which associations between LA measures and dementia were mediated by incident AF.

Results:

A total of 4,096 subjects composed the final cohort. Over a median follow-up of 6 years, 531 (13%) subjects were diagnosed with incident dementia. Measures of LA size were not associated with incident dementia risk. However, several measures of LA function were associated with dementia risk in the fully adjusted model, including reservoir strain, conduit strain, contractile strain, emptying fraction, and active and passive emptying fractions. Incident AF mediated <2% of the association between each of the above measures and incident dementia.

Conclusions:

In this cohort study, several echocardiographic measures of atrial function but not size were associated with an increased risk of dementia without significant mediation from incident AF.

Perspective:

The results of this exploratory study add to the growing body of literature that supports a fascinating and likely complex relationship between heart function and brain health, the latter encompassing not just stroke but also neurodegenerative diseases.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound, Sleep Apnea

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Function, Left, Brain Ischemia, Cognition Disorders, Dementia, Diagnostic Imaging, Echocardiography, Heart Atria, Muscular Diseases, Myopathy, Central Core, Neurodegenerative Diseases, Risk Factors, Secondary Prevention, Stroke, Vascular Diseases


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