{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:57:18Z","timestamp":1790175438862,"version":"4.1.0"},"reference-count":60,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,4,15]]},"abstract":"\n Background<\/jats:title>\n \n The relationship of left atrial (\n LA<\/jats:styled-content>\n ) strain with cognition in the absence of\n atrial fibrillation<\/jats:styled-content>\n is poorly understood. We investigated the association of\n LA<\/jats:styled-content>\n strain with cognitive impairment and its pathogenetic subtype (vascular [\n VCI<\/jats:styled-content>\n ] or neurodegenerative) and underlying mechanisms via associations with circulating and neuroimaging markers of cerebrovascular disease.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n LA<\/jats:styled-content>\n strain (reservoir, conduit [\n LAScd<\/jats:styled-content>\n ], contractile) was determined using speckle\u2010tracking echocardiography in a prospective memory clinic cohort with brain magnetic resonance imaging, neuropsychological assessments, and circulating biomarker measurements. Cognitive impairment was classified as\n VCI<\/jats:styled-content>\n or neurodegenerative in the presence or absence of significant cerebrovascular disease, respectively. Among 251 subjects (age 75\u00b18\u2009years, 59% women) without\n atrial fibrillation<\/jats:styled-content>\n , 178 (71%) had cognitive impairment (20% mild, 14% moderate, 37% dementia); of these impairments, 58% were\n VCI<\/jats:styled-content>\n and 42% neurodegenerative. Only\n LAScd<\/jats:styled-content>\n was associated with more severe cognitive impairment (moderate\/dementia versus none\/mild, adjusted odds ratio\n [aOR<\/jats:styled-content>\n ] for lowest versus highest tertile >2) and specifically, with worse\n Mini\u2010Mental State Examination<\/jats:styled-content>\n score and memory on neuropsychological testing.\n LAScd<\/jats:styled-content>\n was independently associated with\n VCI<\/jats:styled-content>\n (versus neurodegenerative;\n aOR<\/jats:styled-content>\n for lowest versus highest tertile, 4.22 [95%\n CI,<\/jats:styled-content>\n 1.59\u201311.2]) and not with neurodegenerative markers (circulating\n pTau<\/jats:styled-content>\n \u2010181 [phosphorylated tau\u2010181], isolated lobar cerebral microbleeds). Both\n LAScd<\/jats:styled-content>\n and\n LA<\/jats:styled-content>\n reservoir\n strain<\/jats:styled-content>\n were associated with increased burden of cerebral small vessel disease on magnetic resonance imaging, but only\n LAScd<\/jats:styled-content>\n correlated with circulating biomarkers, reflecting inflammation, neurotrophic processes, and neuronal damage.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Reduced\n LA<\/jats:styled-content>\n strain was associated with cognitive impairment, primarily of vascular origin, and a higher burden of cerebral small vessel disease.\n LAScd<\/jats:styled-content>\n may be a biomarker of\n VCI<\/jats:styled-content>\n in at\u2010risk subjects without\n atrial fibrillation<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.123.036931","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T23:19:48Z","timestamp":1744067988000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Left Atrial Myocardial Mechanics: Association With Cognitive Dysfunction, Cerebrovascular Disease, and Circulating Biomarkers"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7273-6883","authenticated-orcid":false,"given":"Eugene S. 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P.","family":"Lai","sequence":"additional","affiliation":[{"name":"National University Health System","place":["Singapore, Singapore"]},{"name":"National University of Singapore","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2869-0096","authenticated-orcid":false,"given":"Joyce","family":"Chong","sequence":"additional","affiliation":[{"name":"National University Health System","place":["Singapore, Singapore"]},{"name":"National University of Singapore","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0381-593X","authenticated-orcid":false,"given":"Caroline","family":"Robert","sequence":"additional","affiliation":[{"name":"National University of Singapore","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4824-0432","authenticated-orcid":false,"given":"Hazliza","family":"Hazli","sequence":"additional","affiliation":[{"name":"National University Heart Centre","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingli","family":"Gong","sequence":"additional","affiliation":[{"name":"National University of Singapore","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine Lunaria","family":"Berboso","sequence":"additional","affiliation":[{"name":"National University of Singapore","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3593-6362","authenticated-orcid":false,"given":"Narayanaswamy","family":"Venketasubramanian","sequence":"additional","affiliation":[{"name":"Raffles Neuroscience Centre","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boon\u2010Yeow","family":"Tan","sequence":"additional","affiliation":[{"name":"St. Luke\u2019s Hospital","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2023-8177","authenticated-orcid":false,"given":"A. Mark","family":"Richards","sequence":"additional","affiliation":[{"name":"National University Heart Centre","place":["Singapore, Singapore"]},{"name":"National University of Singapore","place":["Singapore, Singapore"]},{"name":"Cardiovascular Research Institute","place":["Singapore, Singapore"]},{"name":"University of Otago","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1047-9225","authenticated-orcid":false,"given":"Christopher","family":"Chen","sequence":"additional","affiliation":[{"name":"National University Health System","place":["Singapore, Singapore"]},{"name":"National University of Singapore","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6063-8530","authenticated-orcid":false,"given":"Lieng\u2010Hsi","family":"Ling","sequence":"additional","affiliation":[{"name":"National University Heart Centre","place":["Singapore, Singapore"]},{"name":"National University of Singapore","place":["Singapore, Singapore"]},{"name":"St. Luke\u2019s Hospital","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.055018"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.2022203"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2018.75.2"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.024143"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0538"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw161"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2023.05.010"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.014553"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.018399"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.2518"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.08.006"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.013197"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.026460"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1159\/000519902"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000013249"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2012.10.019"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2020.08.008"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.035133"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-150902"},{"key":"e_1_3_2_21_2","unstructured":"Diagnostic and Statistical Manual of Mental Disorders . 4th ed. 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