{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T16:35:55Z","timestamp":1793723755036,"version":"4.6.1"},"reference-count":37,"publisher":"Elsevier BV","issue":"9","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2023,3,25]],"date-time":"2023-03-25T00:00:00Z","timestamp":1679702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100023392","name":"NIHR Biomedical Research Unit","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100023392","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacc.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["JACC: Cardiovascular Imaging"],"published-print":{"date-parts":[[2023,9]]},"DOI":"10.1016\/j.jcmg.2023.03.006","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T13:59:55Z","timestamp":1684331995000},"page":"1149-1159","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":16,"title":["Reduced Left Atrial Rotational Flow Is\u00a0Independently Associated With Embolic\u00a0Brain Infarcts"],"prefix":"10.1016","volume":"16","author":[{"given":"Marco","family":"Spartera","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Stracquadanio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme","family":"Pessoa-Amorim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Harston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Mazzucco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Von Ende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron T.","family":"Hess","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa M.","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Kennedy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Neubauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Casadei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan S.","family":"Wijesurendra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jcmg.2023.03.006_bib1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0140-6736(09)60040-4","article-title":"Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited","volume":"373","author":"Watson","year":"2009","journal-title":"Lancet"},{"key":"10.1016\/j.jcmg.2023.03.006_bib2","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation","volume":"137","author":"Lip","year":"2010","journal-title":"Chest"},{"key":"10.1016\/j.jcmg.2023.03.006_bib3","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1001\/jama.2015.10725","article-title":"Assessment of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death in patients with heart failure with and without atrial fibrillation","volume":"314","author":"Melgaard","year":"2015","journal-title":"JAMA"},{"key":"10.1016\/j.jcmg.2023.03.006_bib4","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1161\/CIRCULATIONAHA.116.024057","article-title":"Wide variation in reported rates of stroke across cohorts of patients with atrial fibrillation","volume":"135","author":"Quinn","year":"2017","journal-title":"Circulation"},{"key":"10.1016\/j.jcmg.2023.03.006_bib5","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jacc.2019.11.024","article-title":"Embolic stroke of undetermined source: JACC Review Topic of the Week","volume":"75","author":"Ntaios","year":"2020","journal-title":"J\u00a0Am Coll Cardiol"},{"key":"10.1016\/j.jcmg.2023.03.006_bib6","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S1474-4422(13)70310-7","article-title":"Embolic strokes of undetermined source: the case for a new clinical construct","volume":"13","author":"Hart","year":"2014","journal-title":"Lancet Neurol"},{"key":"10.1016\/j.jcmg.2023.03.006_bib7","article-title":"Prevalence and overlap of potential embolic sources in patients with embolic stroke of undetermined source","volume":"8","author":"Ntaios","year":"2019","journal-title":"J\u00a0Am Heart Assoc"},{"key":"10.1016\/j.jcmg.2023.03.006_bib8","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1093\/ehjci\/jeab213","article-title":"The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics","volume":"23","author":"Spartera","year":"2021","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"10.1016\/j.jcmg.2023.03.006_bib9","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12968-021-00729-0","article-title":"Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation","volume":"23","author":"Spartera","year":"2021","journal-title":"J\u00a0Cardiovasc Magn Reson"},{"key":"10.1016\/j.jcmg.2023.03.006_bib10","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.116.004984","article-title":"Left atrial and left atrial appendage 4d blood flow dynamics in atrial fibrillation","volume":"9","author":"Markl","year":"2016","journal-title":"Circ Cardiovasc Imaging"},{"key":"10.1016\/j.jcmg.2023.03.006_bib11","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1038\/35008075","article-title":"Asymmetric redirection of flow through the heart","volume":"404","author":"Kilner","year":"2000","journal-title":"Nature"},{"key":"10.1016\/j.jcmg.2023.03.006_bib12","doi-asserted-by":"crossref","DOI":"10.1038\/srep22021","article-title":"Vortex ring behavior provides the epigenetic blueprint for the human heart","volume":"6","author":"Arvidsson","year":"2016","journal-title":"Sci Rep"},{"key":"10.1016\/j.jcmg.2023.03.006_bib13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pcbi.1005291","article-title":"A\u00a0general shear-dependent model for thrombus formation","volume":"13","author":"Yazdani","year":"2017","journal-title":"PLoS Comput Biol"},{"key":"10.1016\/j.jcmg.2023.03.006_bib14","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-017-17117-3","article-title":"Investigation of atrial vortices using a novel right heart model and possible implications for atrial thrombus formation","volume":"7","author":"Gulan","year":"2017","journal-title":"Sci Rep"},{"key":"10.1016\/j.jcmg.2023.03.006_bib15","doi-asserted-by":"crossref","first-page":"2640","DOI":"10.1253\/circj.CJ-12-0360","article-title":"Abnormal left ventricular vortex flow patterns in association with left ventricular apical thrombus formation in patients with anterior myocardial infarction: a quantitative analysis by contrast echocardiography","volume":"76","author":"Son","year":"2012","journal-title":"Circ J"},{"key":"10.1016\/j.jcmg.2023.03.006_bib16","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1098\/rsif.2011.0041","article-title":"Blood flow and coherent vortices in the normal and aneurysmatic aortas: a fluid dynamical approach to intra-luminal thrombus formation","volume":"8","author":"Biasetti","year":"2011","journal-title":"J\u00a0R Soc Interface"},{"key":"10.1016\/j.jcmg.2023.03.006_bib17","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1016\/j.jacc.2018.12.039","article-title":"Relationships of overt and silent brain lesions with cognitive function in patients with atrial fibrillation","volume":"73","author":"Conen","year":"2019","journal-title":"J\u00a0Am Coll Cardiol"},{"key":"10.1016\/j.jcmg.2023.03.006_bib18","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1093\/ehjci\/jez226","article-title":"Cardiovascular risk scoring and magnetic resonance imaging detected subclinical cerebrovascular disease","volume":"21","author":"Anand","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"10.1016\/j.jcmg.2023.03.006_bib19","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1177\/2047487317726068","article-title":"Predictive role of CHA2DS2-VASc score for cardiovascular events and death in patients with arterial hypertension and stable sinus rhythm","volume":"24","author":"Mazzone","year":"2017","journal-title":"Eur J Prev Cardiol"},{"key":"10.1016\/j.jcmg.2023.03.006_bib20","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1212\/WNL.0b013e318287281b","article-title":"CHADS(2), CHA(2)S(2)DS(2)-VASc, and long-term stroke outcome in patients without atrial fibrillation","volume":"80","author":"Ntaios","year":"2013","journal-title":"Neurology"},{"key":"10.1016\/j.jcmg.2023.03.006_bib21","author":"Spartera"},{"key":"10.1016\/j.jcmg.2023.03.006_bib22","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1212\/WNL.0b013e318293e15f","article-title":"MRI findings and stroke risk in TIA patients with different symptom durations","volume":"80","author":"Al-Khaled","year":"2013","journal-title":"Neurology"},{"key":"10.1016\/j.jcmg.2023.03.006_bib23","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S1474-4422(13)70124-8","article-title":"Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration","volume":"12","author":"Wardlaw","year":"2013","journal-title":"Lancet Neurol"},{"key":"10.1016\/j.jcmg.2023.03.006_bib24","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1253\/jcj.48.50","article-title":"Clinical and neuroradiological analysis of thrombotic and embolic cerebral infarction","volume":"48","author":"Yamaguchi","year":"1984","journal-title":"Jpn Circ J"},{"key":"10.1016\/j.jcmg.2023.03.006_bib25","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1161\/01.CIR.92.4.835","article-title":"Left atrial size and the risk of\u00a0stroke and death","volume":"92","author":"Benjamin","year":"1995","journal-title":"Circulation"},{"key":"10.1016\/j.jcmg.2023.03.006_bib26","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1093\/eurheartj\/ehx736","article-title":"Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry","volume":"39","author":"Leung","year":"2017","journal-title":"Eur Heart J"},{"key":"10.1016\/j.jcmg.2023.03.006_bib27","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/S0894-7317(99)70105-7","article-title":"Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: I. Reduced flow velocity in the left atrial appendage (The Stroke Prevention in Atrial Fibrillation [SPAF-III] study)","volume":"12","author":"Goldman","year":"1999","journal-title":"J\u00a0Am Soc Echocardiogr"},{"key":"10.1016\/j.jcmg.2023.03.006_bib28","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/0735-1097(94)90025-6","article-title":"Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation","volume":"24","author":"Leung","year":"1994","journal-title":"J\u00a0Am Coll Cardiol"},{"key":"10.1016\/j.jcmg.2023.03.006_bib29","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jcmg.2012.10.019","article-title":"LA volumes and reservoir function are associated with subclinical cerebrovascular disease: the CABL (Cardiovascular Abnormalities and Brain Lesions) study","volume":"6","author":"Russo","year":"2013","journal-title":"J\u00a0Am Coll Cardiol Img"},{"key":"10.1016\/j.jcmg.2023.03.006_bib30","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/0140-6736(90)90815-M","article-title":"Shear-induced platelet aggregation","volume":"335","author":"O'Brien","year":"1990","journal-title":"Lancet"},{"key":"10.1016\/j.jcmg.2023.03.006_bib31","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"10.1016\/j.jcmg.2023.03.006_bib32","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1093\/eurheartj\/ehr488","article-title":"Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study","volume":"33","author":"Friberg","year":"2012","journal-title":"Eur Heart J"},{"key":"10.1016\/j.jcmg.2023.03.006_bib33","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1161\/STROKEAHA.115.008711","article-title":"Left atrial enlargement and stroke recurrence: the Northern Manhattan Stroke Study","volume":"46","author":"Yaghi","year":"2015","journal-title":"Stroke"},{"key":"10.1016\/j.jcmg.2023.03.006_bib34","doi-asserted-by":"crossref","first-page":"2417","DOI":"10.1016\/j.jcmg.2019.02.021","article-title":"Left atrial mechanical function and incident ischemic cerebrovascular events independent of AF: insights From the MESA Study","volume":"12","author":"Habibi","year":"2019","journal-title":"J\u00a0Am Coll Cardiol Img"},{"key":"10.1016\/j.jcmg.2023.03.006_bib35","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1161\/STROKEAHA.117.019641","article-title":"Patients with undetermined stroke have increased atrial fibrosis: a cardiac magnetic resonance imaging study","volume":"49","author":"Fonseca","year":"2018","journal-title":"Stroke"},{"key":"10.1016\/j.jcmg.2023.03.006_bib36","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1161\/CIRCRESAHA.117.311170","article-title":"Brain-heart interaction: cardiac complications after stroke","volume":"121","author":"Chen","year":"2017","journal-title":"Circ Res"},{"key":"10.1016\/j.jcmg.2023.03.006_bib37","doi-asserted-by":"crossref","first-page":"3554","DOI":"10.1161\/STROKEAHA.115.011273","article-title":"Left atrial appendage function and stroke risk","volume":"46","author":"Yaghi","year":"2015","journal-title":"Stroke"}],"container-title":["JACC: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1936878X23001493?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1936878X23001493?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:54:34Z","timestamp":1761846874000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1936878X23001493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":37,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["S1936878X23001493"],"URL":"https:\/\/doi.org\/10.1016\/j.jcmg.2023.03.006","relation":{},"ISSN":["1936-878X"],"issn-type":[{"value":"1936-878X","type":"print"}],"subject":[],"published":{"date-parts":[[2023,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Reduced Left Atrial Rotational Flow Is\u00a0Independently Associated With Embolic\u00a0Brain Infarcts","name":"articletitle","label":"Article Title"},{"value":"JACC: Cardiovascular Imaging","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jcmg.2023.03.006","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2023 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.","name":"copyright","label":"Copyright"}]}}