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Clinical Trial
. 2016 Aug 3:6:31042.
doi: 10.1038/srep31042.

Left atrial enlargement is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial fibrillation

Yasuhiro Hamatani  1 , Hisashi Ogawa  1 , Kensuke Takabayashi  1 , Yugo Yamashita  1 , Daisuke Takagi  1 , Masahiro Esato  2 , Yeong-Hwa Chun  2 , Hikari Tsuji  3 , Hiromichi Wada  4 , Koji Hasegawa  4 , Mitsuru Abe  1 , Gregory Y H Lip  5   6 , Masaharu Akao  1
Affiliations
Clinical Trial

Left atrial enlargement is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial fibrillation

Yasuhiro Hamatani et al. Sci Rep. .

Abstract

Controversy exists regarding whether left atrial enlargement (LAE) is a predictor of stroke/systemic embolism (SE) in atrial fibrillation (AF) patients. The Fushimi AF Registry, a community-based prospective survey, enrolled all AF patients in Fushmi-ku, Japan, from March 2011. Follow-up data and baseline echocardiographic data were available for 2,713 patients by August 2015. We compared backgrounds and incidence of events over a median follow-up of 976.5 days between patients with LAE (left atrial diameter > 45 mm; LAE group) and those without in the Fushimi AF Registry. The LAE group accounted for 39% (n = 1,049) of cohort. The LAE group was older and had longer AF duration, with more prevalent non-paroxysmal AF, higher CHADS2/CHA2DS2-VASc score, and oral anticoagulant (OAC) use. A higher risk of stroke/SE during follow-up in the LAE group was found (entire cohort; hazard ratio (HR): 1.92, 95% confidence interval (CI): 1.40-2.64; p < 0.01; without OAC; HR: 1.97, 95% CI: 1.18-3.25; p < 0.01; with OAC; HR: 1.83, 95% CI: 1.21-2.82; p < 0.01). LAE was independently associated with increased risk of stroke/SE (HR: 1.74, 95% CI: 1.25-2.42; p < 0.01) after adjustment by the components of CHA2DS2-VASc score and OAC use. In conclusion, LAE was an independent predictor of stroke/SE in large community cohort of AF patients.

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Conflict of interest statement

Dr. Akao received lecture fees from Pfizer, Bristol Myers Squibb, Boehringer Ingelheim, Bayer Healthcare and Daiichi-Sankyo. Dr Lip has served as a consultant or advisory board for Bayer/ Janssen, Astellas, Merck, Sanofi, BMS/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim, Microlife and Daiichi-Sankyo, and has been on the speakers bureau for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1
Figure 1. Distributions of left atrial diameter.
(a) Entire cohort. (b) Patients with paroxysmal atrial fibrillation (AF). (c) Patients with sustained AF. AF = atrial fibrillation.
Figure 2
Figure 2. Kaplan-Meier curves for the incidence of stroke or systemic embolism (SE) during follow-up period.
(a) Entire cohort, (b) Patients without oral anticoagulant (OAC). (c) Patients with OAC at baseline. CI = confidence interval, HR = hazard ratio, LAE = left atrial enlargement, OAC = oral anticoagulant, SE = systemic embolism.
Figure 3
Figure 3. Impact of left atrial enlargement (left atrial diameter > 45 mm) on the incidence of stroke or systemic embolism, according to major subgroups.
AF = atrial fibrillation, CI = confidence interval, LAE = left atrial enlargement.
Figure 4
Figure 4. Kaplan-Meier curves for the incidence of stroke or systemic embolism (SE) according to 4 left atrial diameter strata (≤40 mm vs. 40–45 mm vs. 45–50 mm vs. >50 mm).
SE = systemic embolism.
See this image and copyright information in PMC

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