What is the clinical evidence from this study?

Study design: Cohort. Population: Non-valvular atrial fibrillation (n=2713). Intervention: Left atrial enlargement (LA diameter > 45 mm) vs. No left atrial enlargement (LA diameter ≤ 45 mm). Primary outcome: Incidence of stroke or systemic embolism (HR 1.74, 95% CI 1.25-2.42, p=<0.01).

August 3, 2016Open Access

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

Q: What are the key findings of this study?

Left atrial enlargement was independently associated with an increased risk of stroke and systemic embolism (HR 1.74) compared to no enlargement in patients with non-valvular atrial fibrillation.

Resultado clave

Left atrial enlargement was independently associated with an increased risk of stroke and systemic embolism (HR 1.74) compared to no enlargement in patients with non-valvular atrial fibrillation.

Diseño del estudio

Tipo

Cohort (n=2,713)

Multicéntrico

Sí

PICO estructurado

Does left atrial enlargement predict stroke and systemic embolism in patients with non-valvular atrial fibrillation?

Población

2,713 patients with non-valvular atrial fibrillation from the Fushimi AF Registry (a community-based prospective survey in Japan). Excluded: missing left atrial diameter data, mitral stenosis, and/or prior cardiac valve surgery.

Intervención

Left atrial enlargement (LAE), defined as left atrial diameter > 45 mm measured by echocardiography

Comparador

No left atrial enlargement (left atrial diameter ≤ 45 mm)

Resultado

Incidence of stroke or systemic embolism (SE) during follow-up periodhard clinical

Left atrial enlargement (>45 mm) is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial fibrillation, providing incremental risk stratification beyond the CHA2DS2-VASc score.

Resultado numérico

Estimación del efecto: HR 1.74 (95% CI 1.25-2.42)

Tasa de eventos absoluta: 3.4% vs 1.7%

valor p: p=<0.01

Limitaciones

Observational study design cannot rule out unmeasured confounders.
Measured only left atrial anterior-posterior diameter rather than left atrial volume.
Missing left atrial echocardiographic data in 809 patients may introduce selection bias.
Atrial fibrillation duration data were available for only a subset of patients and relied on self-report or physician judgment.
Antithrombotic therapy was selected at physician discretion and assessed only at baseline.
Blood pressure was only collected at entry without 24-hour monitoring.

Resumen

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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