Transthoracic Transmitral Atrial Flow is Independently Associated with Ischemic Stroke Risk in Paroxysmal Atrial Fibrillation.
Journal
Thrombosis and haemostasis
ISSN
2567-689X
Date Issued
2026-01-30
Author(s)
Chua, Su-Kiat
Huang, Pang-Shuo
Chen, Jien-Jiun
Chiu, Fu-Chun
Wang, Chih-Hsien
Abstract
Atrial fibrillation (AF) significantly increases the risk of ischemic stroke. This study evaluates whether transmitral atrial flow velocity (MVA), measured non-invasively via transthoracic echocardiography (TTE), predicts stroke risk in AF patients.To assess the independent association between TTE-derived MVA and stroke incidence in paroxysmal AF patients and its value in refining risk stratification, especially in low-risk groups.This cohort study included 10,150 paroxysmal AF patients from 2010 to 2021. The primary outcome was hospitalization for ischemic stroke. Multivariable Cox regression analyses adjusted for CHADS-VASc scores evaluated the relationship between MVA and stroke risk.Over a mean follow-up of 4.26 ± 3.52 years, 2,419 (23.8%) patients developed ischemic strokes (5.59% per 100 person-years). In multivariable analysis, adjusting for CHADS-VASc score, MVA was independently associated with stroke incidence. Every 10 cm/s reduction in MVA velocity conferred 4% higher stroke risk (adjusted hazard ratio [HR] 0.96 [0.94-0.97], < 0.001). AF patients with MVA < 50 cm/s had a 39% increase in stroke risk compared to those with MVA ≥ 50 cm/s (adjusted HR 1.39 [1.22-1.58], < 0.001). In patients with a CHADS-VASc score of 0 or 1, the stroke incidence increased from 1.33 to 2.28% when they had MVA < 50 cm/s, which was similar to that of patients with a CHADS-VASc score of 2 points (2.51%).TTE-derived MVA independently predicts stroke risk in paroxysmal AF patients. Incorporating MVA enhances risk stratification and guides targeted stroke prevention, particularly in low-risk populations.
Type
journal article