August 3, 2016Scientific ReportsOpen 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.

Q: 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).

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Key result

Left atrial enlargement linked to ~74% greater stroke and systemic embolism risk in non-valvular AF.

HR 1.74
95% CI 1.25-2.42
P<0.01
n=2,713

Why the study?

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

Study Design

Type

Cohort (n=2,713)

Multicenter

Yes

Structured PICO

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

Population

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.

Intervention

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

Comparator

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

Outcome

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

Main Result

Effect estimate: HR 1.74 (95% CI 1.25-2.42)

Absolute Event Rate: 3.4% vs 1.7%

p-value: p=<0.01

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.

Limitations

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.
Observational study provides only associative evidence, cannot rule out unmeasured confounders
Measured only left atrial anterior-posterior diameter, not left atrial volume
Missing left atrial echocardiographic data in 809 patients, leading to selection bias
AF duration data were available for only 1,771 patients and mostly based on physician's judgement or patient's self-report
Antithrombotic therapy selected at the discretion of the attending physician, and stratified by OAC prescription only at baseline
Did not measure 24-hour blood pressure and collected blood pressure data only at the time of entry

Discussion

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Implication

Left atrial enlargement may refine stroke risk stratification in non-valvular AF; leaves open whether it improves CHA2DS2-VASc-guided decisions.

Cite This Study

Hamatani et al. (2016) conducted a cohort in Non-valvular atrial fibrillation (n=2,713). Left atrial enlargement (LA diameter > 45 mm) vs. No left atrial enlargement (LA diameter ≤ 45 mm) was evaluated on Incidence of stroke or systemic embolism (HR 1.74, 95% CI 1.25-2.42, p=<0.01). 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.

synapsesocial.com/papers/6a0f2efa14089a5783bdd048 https://doi.org/10.1038/srep31042

Topics

Atrial fibrillation Persistent AF management Echocardiography Anticoagulation in AF

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Implication

Left atrial enlargement may refine stroke risk stratification in non-valvular AF; leaves open whether it improves CHA2DS2-VASc-guided decisions.

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

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

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

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider