Elsevier

Mayo Clinic Proceedings

Volume 79, Issue 8, August 2004, Pages 1008-1014
Mayo Clinic Proceedings

Original Article
Left Atrial Volume in the Prediction of First Ischemic Stroke in an Elderly Cohort Without Atrial Fibrillation

https://doi.org/10.4065/79.8.1008Get rights and content

OBJECTIVE

To determine the clinical importance of left atrial (LA) volume in the prediction of first ischemic stroke.

PATIENTS AND METHODS

This retrospective cohort study included randomly selected residents of Olmsted County, Minnesota, aged 65 years or older, who had undergone transthoracic echocardiography at least once at the Mayo Clinic in Rochester, Minn, between January 1, 1990, and December 31, 1998, were in sinus rhythm, and had no history of stroke, transient ischemic attack, atrial fibrillation, or valvular heart disease. Patients were monitored through medical records for first ischemic stroke or death.

RESULTS

Of 1554 residents (59% women) aged 75±7 years, 92 (6%) had experienced at least 1 ischemic stroke over 4.3±2.7 years (incident stroke rate, 1.4 per 100 person-years). Left atrial volume of 32 mL/m2 or greater (hazard ratio [HR], 1.63; confidence interval [CI], 1.08-2.46) was independent of age (HR, 1.04; CI, 1.02-1.07), diabetes (HR, 1.91; CI, 1.07-3.41), myocardial infarction (HR, 1.64; CI, 1.01-2.64), and hyperlipidemia (HR, 1.55; CI, 1.01-2.37) for the prediction of first ischemic stroke. When quartiles of LA dimension were plotted against quartiles of indexed LA volume, a stepwise increase in risk with each quartile increment was evident only for indexed LA volume. Also, an LA volume of 32 mL/m2 or greater was associated with an increased mortality risk (HR, 1.30; CI, 1.09-1.56), independent of age, sex, and stroke status.

CONCLUSIONS

In our elderly cohort with no prior atrial fibrillation, LA volume was independently predictive of first ischemic stroke, incremental to age, diabetes, myocardial infarction, and hyperlipidemia. It was also an independent predictor of death.

Section snippets

PATIENTS AND METHODS

After obtaining approval from the Mayo Foundation Institutional Review Board for this retrospective cohort study, we identified potential subjects from a computerized search of the echocardiography database and excluded patients who had not authorized use of their records (N=159). Search criteria included residence in Olmsted County, Minnesota, a record of undergoing transthoracic echocardiography at least once at the Mayo Clinic, Olmsted Medical Center, or their affiliated hospitals between

Predictors of First Ischemic Stroke

A total of 1554 residents in Olmsted County fulfilled all study criteria (920 women, 634 men). The mean ± SD age was 75+7 years (range, 65-100 years), and 92 residents (6%) had experienced 1 or more ischemic strokes over a mean ± SD follow-up period of 4.3+2.7 years. The incident stroke rate was 1.4 per 100 person-years.

The clinical, electrocardiographic, and echocardiographic characteristics of the cohort are shown in Table 1. Echocardiographic referral indications for these patients included

Prediction of First Ischemic Stroke: Clinical Implications of LA Size

The 3 principal findings of our study were as follows: (1) indexed LA volume contributes significantly and independently to the prediction of first ischemic stroke in elderly patients with no history of AF at baseline; (2) important differences exist between the use of conventional M-mode LA dimension and 2-dimensional biplane-indexed LA volume for ischemic stroke prediction, with indexed LA volume being more sensitive to change in stroke risk across the spectrum of LA size; and (3) enlarged LA

CONCLUSIONS

Echocardiographic assessment of LA volume provides a simple and quantitative assessment of risk for first ischemic stroke, independent of and incremental to clinical stroke risk factors. It is also an independent predictor of death.

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This study was supported by a grant from the American Society of Echocardiography.

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