Response to Letter Regarding Article, “Subclinical Left Ventricular Dysfunction and Silent Cerebrovascular Disease: The Cardiovascular Abnormalities and Brain Lesions (CABL) Study”

In their Letter to the Editor about our recent publication,¹ Drs Rai and Bughio correctly point out that we previously demonstrated that left atrial (LA) phasic volumes were independent predictors of subclinical brain disease.² We agree that LA strain (LAε) can detect early LA dysfunction and may be also associated with subclinical brain disease. In fact, we recently described the independent association between LAε and silent brain infarcts.³ In that study, peak positive longitudinal LAε and strain rate were associated with silent brain infarcts, with adjusted odds ratios of 2.46 and 2.39 per 1-SD decrease, respectively (both P<0.001). However, measuring highly complex speckle-tracking parameters such as LAε in large community-based studies not specifically designed for that purpose can be difficult. In our study, optimal LAε …