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