RT Journal Article
SR Electronic
T1 Left atrial size and risk for all-cause mortality and ischemic stroke
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E657
OP E664
DO 10.1503/cmaj.091688
VO 183
IS 10
A1 Alberto Bouzas-Mosquera
A1 Francisco J. Broullón
A1 Nemesio Álvarez-García
A1 Elizabet Méndez
A1 Jesús Peteiro
A1 Teresa Gándara-Sambade
A1 Oscar Prada
A1 Víctor X. Mosquera
A1 Alfonso Castro-Beiras
YR 2011
UL http://www.cmaj.ca/content/183/10/E657.abstract
AB Background: Limited data are available on the relation between left atrial size and outcome among patients referred for clinically indicated echocardiograms. Our aim was to assess the association of left atrial size with all-cause mortality and ischemic stroke in a large cohort of patients referred for echocardiography. Methods: Left atrial diameter was measured in 52 639 patients aged 18 years or older (mean age 61.8 [standard deviation (SD) 16.3] years; 52.9% men) who underwent a first transthoracic echocardiogram for clinical reasons at our institution between April 1990 and March 2008. The outcomes were all-cause mortality and nonfatal ischemic stroke. Results: Based on the criteria of the American Society of Echocardiography, 50.4% of the patients had no left atrial enlargement, whereas 24.5% had mild, 13.3% had moderate and 11.7% had severe left atrial enlargement. Over a mean follow-up period of 5.5 (SD 4.1) years, 12 527 patients died, and 2314 patients had a nonfatal ischemic stroke. Cumulative 10-year survival was 73.7% among patients with normal left atrial size, 62.5% among those with mild enlargement, 54.8% among those with moderate enlargement and 45% among those with severe enlargement (p < 0.001). After adjustment in multivariable Cox proportional hazard analysis, left atrial diameter remained a predictor of all-cause mortality in both sexes (hazard ratio [HR] per 1-cm increment in left atrial size 1.17, 95% confidence interval [CI] 1.12–1.22, p < 0.001 in women, and HR 1.09, 95% CI 1.05–1.13, p < 0.001 in men) and of ischemic stroke in women (HR 1.25, 95% CI 1.14–1.37, p < 0.001). Interpretation: Left atrial diameter has a graded and independent association with all-cause mortality in both sexes and with ischemic stroke in women.See related commentary by Goldstein at www.cmaj.ca/lookup/doi/10.1503/cmaj.110617