Background
Left atrial enlargement (LAE) is independently associated with an increased risk of
stroke and atrial fibrillation (AF). The combination of both LAE and AF possibly increases
the risk of stroke beyond that observed with AF.
Methods
This analysis included 4572 (43% men, 95% white) participants from the Cardiovascular
Health Study. LAE was defined using transthoracic echocardiographic 2-dimensional
M-mode measurements of the left atrial diameter using sex-specific cut-points (men:
≥4.1 cm, women: ≥3.9 cm). AF cases were identified during the initial study electrocardiogram
or by self-reported history. We examined the association between baseline AF and incident
ischemic stroke stratified by the presence of LAE. Incident cases of ischemic stroke
were identified by adjudication of medical records, including hospitalization data,
through December 31, 2010.
Results
At baseline, a total of 253 (5.5%) participants had AF and 1947 (43%) had LAE. Participants
with AF (n = 163, 64%) were more likely to have LAE than those without AF (n = 1784,
41%; P < .001). Over a median follow-up of 13 years, 739 (16%) ischemic stroke events were
identified. Both AF (hazard ratio [HR] = 2.12, 95% confidence interval [CI] = 1.64-2.74)
and left atrial diameter (per 1-cm increase: HR = 1.14, 95% CI = 1.01-1.28) were associated
with an increased risk for ischemic stroke. The association between AF and ischemic
stroke was not modified by the presence of LAE (LAE: HR = 2.13, 95% CI = 1.42-3.19;
no LAE: HR = 1.91, 95% CI = 1.36-2.68; P interaction = .86).
Conclusion
Our results suggest that echocardiographic LAE does not modify the stroke risk observed
with AF.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study.JAMA. 2001; 285: 2370-2375
- Atrial fibrillation as an independent risk factor for stroke: the Framingham study.Stroke. 1991; 22: 983-988
- Left atrial size and the risk of stroke and death. The Framingham Heart Study.Circulation. 1995; 92: 835-841
- Left atrial size and the risk of ischemic stroke in an ethnically mixed population.Stroke. 1999; 30: 2019-2024
- M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study).Am J Cardiol. 2001; 87: 1051-1057
- The predictive value of left atrial size for incident ischemic stroke and all-cause mortality in African Americans: the Atherosclerosis Risk in Communities (ARIC) study.Stroke. 2008; 39: 2701-2706
- Left atrial size and risk for all-cause mortality and ischemic stroke.CMAJ. 2011; 183: E657-E664
- Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation.Mayo Clin Proc. 2004; 79: 1008-1014
- Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study.Circulation. 1994; 89: 724-730
- Incidence of and risk factors for atrial fibrillation in older adults.Circulation. 1997; 96: 2455-2461
- Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women.Mayo Clin Proc. 2001; 76: 467-475
- The Cardiovascular Health Study: design and rationale.Ann Epidemiol. 1991; 1: 263-276
- Echocardiographic design of a multicenter investigation of free-living elderly subjects: the Cardiovascular Health Study.J Am Soc Echocardiogr. 1992; 5: 63-72
- Recommendations for chamber quantification.Eur J Echocardiogr. 2006; 7: 79-108
- Methods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study.Ann Epidemiol. 1995; 5: 270-277
- Surveillance and ascertainment of cardiovascular events. The Cardiovascular Health Study.Ann Epidemiol. 1995; 5: 278-285
- Assessment of cerebrovascular disease in the Cardiovascular Health Study.Ann Epidemiol. 1993; 3: 504-507
- Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2013; 127: 1425-1443
- A linear rank test for use when the main interest is in differences in cure rates.Biometrics. 1989; 45: 899-904
- Electrocardiographic left atrial abnormality and stroke subtype in ARIC.Ann Neurol. 2015; 78: 670-678
- Brachial flow-mediated dilation and incident atrial fibrillation: the multi-ethnic study of atherosclerosis.Arterioscler Thromb Vasc Biol. 2014; 34: 2717-2720
- Downregulation of endocardial nitric oxide synthase expression and nitric oxide production in atrial fibrillation: potential mechanisms for atrial thrombosis and stroke.Circulation. 2002; 106: 2854-2858
- Histological substrate of atrial biopsies in patients with lone atrial fibrillation.Circulation. 1997; 96: 1180-1184
- Electromechanical dysfunction of the left atrium associated with interatrial block.Am Heart J. 2001; 142: 823-827
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation.Chest. 2010; 137: 263-272
Article info
Publication history
Published online: March 21, 2016
Accepted:
February 1,
2016
Received in revised form:
January 24,
2016
Received:
November 29,
2015
Footnotes
This article was prepared using Cardiovascular Health Study research materials obtained from the National Heart, Lung, and Blood Institute Biologic Specimen and Data Repository Information Coordinating Center, and does not necessarily reflect the opinions or views of the Cardiovascular Health Study or the National Heart, Lung, and Blood Institute.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.02.004
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
