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Thromb Haemost
DOI: 10.1055/a-2760-8134
Original Article

Transthoracic Transmitral Atrial Flow is Independently Associated with Ischemic Stroke Risk in Paroxysmal Atrial Fibrillation

Authors

  • Su-Kiat Chua 

    1   Shin Kong Wu Ho Su Memorial Hospital, Taipei City, Taiwan (Ringgold ID: RIN38029)

  • Pang-Shuo Huang

    2   Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan (Ringgold ID: RIN37999)

  • Jien-Jiun Chen

    2   Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan (Ringgold ID: RIN37999)

  • FU-CHUN CHIU

    3   National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan (Ringgold ID: RIN37999)

  • Juey-Jen Hwang

    4   National Taiwan University Hospital, TAIPEI, Taiwan (Ringgold ID: RIN38006)

  • Chih-Hsien Wang

    5   Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan (Ringgold ID: RIN38006)

  • Yi-Chih Wang

    6   National Taiwan University Hospital, Taipei City, Taiwan (Ringgold ID: RIN38006)

  • Chia-Ti Tsai

    7   Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan (Ringgold ID: RIN38006)
Further Information
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Background: 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. Objectives: 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. Methods: This cohort study included 10,150 paroxysmal AF from 2010 to 2021. The primary outcome was hospitalization for ischemic stroke. Multivariable Cox regression analyses adjusted for CHA2DS2-VASc scores evaluated the relationship between MVA and stroke risk. Results: Over a mean follow-up of 4.26±3.52years, 2,419 (23.8%) patients developed ischemic strokes (5.59% per 100 person-years). On multivariable analysis adjusting for CHA2DS2-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], P<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], P<0.001). In patients with a CHA2DS2-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 those with CHA2DS2-VASc score of 2 points (2.51 %). Conclusions: 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.



Publication History

Received: 11 February 2025

Accepted after revision: 01 December 2025

Accepted Manuscript online:
16 January 2026

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