This is a review of a recent paper by Daccarett
et al (1), investigating LA remodeling, as assessed by magnetic resonance
imaging (MRI), as a risk factor for stroke. A major motivation for treatment of atrial fibrillation (AF) is to
reduce the risk of stroke, which often arises from emboli formed in the static
left atrium (LA). Risk stratification
for stroke in AF patients, important because it determines the use of anti-coagulants
in patients, is clinically performed using the validated CHADS2 score
(based on prior stroke, diabetes, hypertension, advanced age, and congestive
heart-failure). However, because of its
limited predictive power, patients with low, moderate and high risk CHADS2 scores are often prescribed anti-coagulants in equal frequencies (2).
There is growing evidence that the burden of AF (i.e. the amount of time that
patient remains in AF rhythm) may be a predictor of stroke (3), since during
this time emboli can form in the LA appendage (4).
Credits: Dana C. Peters MD