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Association of left Atrial Fibrosis detected by delayed enhancement magnetic resonance imaging and risk of stroke in patients with Atrial Fibrillation.

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

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