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

Background Although 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. Methods We 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. Results The 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. Conclusions In patients with paroxysmal AF, the elevated LV filling pressure estimated by E/Em is independently associated with the presence of stroke or TIA.