What can the heart tell us about the brain?

A whole lot, says Lin Yee Chen, MD, MS, the Fred C. and Katherine B. Andersen Chair in Adult Cardiology and director of the U’s Lillehei Heart Institute at the University of Minnesota Medical School. According to Chen, a recent breakthrough in understanding heart conditions may hold the key to preventing brain-related conditions like stroke and dementia.

Atrial fibrillation (AF), a type of abnormal heartbeat, has long been associated with ischemic stroke and dementia. However, Chen says, increasing evidence suggests that an important driver of risk is actually atrial myopathy, a condition that causes abnormalities in the function and structure of the heart’s left atrium, which disrupts normal blood flow in the heart.

“Why is this important? Because right now, the medical field is very focused on trying to determine whether patients have AF to prevent stroke. However, AF is often nonsymptomatic and intermittent, which makes it hard to diagnose,” says Chen, who is also an M Health Fairview cardiac electrophysiologist. “There are a lot of people with atrial myopathy who are at high risk for stroke and dementia, and it is easier to diagnose atrial myopathy to prevent [those conditions].”

Atrial myopathy can be diagnosed using echocardiography (a type of heart ultrasound) and is much more straightforward than diagnosing AF. Once a patient has an atrial myopathy diagnosis, Chen says there are opportunities to treat the condition and reduce the risk of stroke or developing dementia.

Chen and his team are currently planning a multicenter study that will test whether oral anticoagulant use in people with atrial myopathy can reduce the risk of stroke, cognitive impairment, dementia, and death. If this approach works, Chen estimates that half a million American lives could be saved from these conditions every year.

“This study is important because we have identified a risk factor—atrial myopathy—that thus far is under-recognized,” he says. “Moreover, it is a risk factor that is targetable using an intervention that is safe and effective, and that can potentially reduce the burden of two important public health problems— stroke and dementia—that are endemic in our aging populations.”