In a recent edition of the Annals of Noninvasive Electrocardiology, Choi et al. published an article on predictors of stroke or systemic embolism in patients with nonvalvular atrial fibrillation (AF) with CHA₂DS₂-VASc score of 0 (Choi et al., 2023). It was a retrospective study evaluating the predictors of stroke and systemic embolism in AF patients with a very low risk of stroke. Also, it emphasized that the rate of stroke and systemic embolism as primary outcome was 0.78%/year in these low-risk patients and that age of ≥50 years, LVEDD of ≥46 mm, and nonparoxysmal AF were independent predictors. Moreover, the authors showed that the prognostic effect of the combined use of independent risk factors was stronger in predicting stroke or systemic embolism in patients with AF stratified into very-low-risk groups in the CHA₂DS₂-VASc scoring system.

Left atrial (LA) remodeling is an important underlying substrate for AF and stroke (Delgado et al., 2017). However, the authors in this study included only the left atrium A-P diameter for left atrial echocardiographic evaluation. Previously, it has been demonstrated that LA size is a valuable marker for AF, stroke, or even “stroke regardless of AF status” (Tiwari et al., 2016). Additionally, it was reported that AF may occur in patients with normal LA dimensions. The occurrence of AF in patients with normal LA size is explained by LA functional remodeling.

Left atrial remodeling refers to the spectrum of pathophysiological changes in atrial structure and physiological function. Recently, more and more attention has been given to the holistic assessment of LA function. Moreover, left atrial structural and functional parameters are evaluated in many cardiac settings other than AF and stroke (Murat et al., 2023). Left atrial reservoir strain, when added to the CHA₂DS₂-VASc variables, has been shown to improve stroke prediction in people without prior AF or stroke (Maheshwari et al., 2023). Pagola et al. investigated the effect of LA dysfunction markers in predicting paroxysmal AF episodes with a high risk of embolization in patients with cryptogenic stroke. In this study, they reported the presence of silent AF in 86% of cryptogenic stroke patients with normal LA size and decreased LA strain (Pagola et al., 2021).

Although the present study did not primarily aim to examine echocardiographic parameters associated with AF and stroke, its results are important because it represents a specific population with a CHA₂DS₂-VASc score of 0. However, in low-risk cases with normal LA dimensions, adding structural and functional holistic evaluation of LA, other than LA dimension, to the CHA₂DS₂-VASc score may reveal important results in predicting stroke and systemic embolism.

在最近一期的《无创心电学年鉴》中，Choi 等人。_{发表了一篇关于 CHA 2} DS ₂ -VASc 评分为 0的非瓣膜性房颤 (AF) 患者中风或全身性栓塞预测因素的文章（Choi 等人，  2023）。这是一项回顾性研究，评估中风风险极低的 AF 患者中风和全身性栓塞的预测因素。此外，它还强调，在这些低风险患者中，作为主要结局的卒中和全身性栓塞发生率为 0.78%/年，年龄≥50 岁、LVEDD ≥46 mm 和非阵发性 AF 是独立的预测因素。_{此外，作者表明，对于在 CHA 2} DS ₂ -VASc 评分系统中分层为极低风险组的 AF 患者，联合使用独立危险因素对于预测卒中或全身性栓塞的预后效果更强。

左心房 (LA) 重塑是 AF 和中风的重要基础 (Delgado et al.,  2017 )。然而，本研究的作者仅将左心房 AP 直径纳入左心房超声心动图评估。此前，已经证明 LA 大小是 AF、中风甚至“无论 AF 状态如何中风”的有价值的标志（Tiwari 等，  2016）。此外，据报道，房颤可能发生在左心房尺寸正常的患者中。LA 大小正常的患者发生 AF 的原因是 LA 功能重塑。

左心房重构是指心房结构和生理功能的一系列病理生理变化。近年来，LA功能的整体评估越来越受到人们的关注。此外，左心房的结构和功能参数在除 AF 和中风之外的许多心脏环境中进行评估（Murat 等人，  2023）。当添加到 CHA ₂ DS ₂ -VASc 变量中时，左心房储备应变已被证明可以改善先前没有 AF 或中风的人群的中风预测（Maheshwari 等人，  2023））。帕戈拉等人。研究了 LA 功能障碍标记物在预测隐​​源性中风患者栓塞高风险的阵发性 AF 发作中的作用。在这项研究中，他们报告了 86% 的隐源性中风患者存在无症状房颤，这些患者的 LA 大小正常且 LA 应变减少（Pagola 等人，  2021）。

_{尽管本研究的主要目的不是检查与 AF 和中风相关的超声心动图参数，但其结果很重要，因为它代表了 CHA 2} DS ₂ -VASc评分为 0 的特定人群。然而，在 LA 正常的低风险病例中维度，将 LA 的结构和功能整体评估（除 LA 维度外）添加到 CHA ₂ DS ₂ -VASc 评分中可能会揭示预测中风和全身性栓塞的重要结果。