Key result
Significant left atrial enlargement was associated with a higher risk of stroke or systemic embolism (HR 1.57) compared to no or mild enlargement in patients with atrial fibrillation.
Why the study?
The clinical implication of left atrial enlargement based on left atrial anterior-posterior dimension or volume index in Korean patients with atrial fibrillation needed evaluation.
Does significant left atrial enlargement increase the risk of stroke or systemic embolism in patients with atrial fibrillation?
Cohort (n=8,159)
Yes
Does significant left atrial enlargement increase the risk of stroke or systemic embolism in patients with atrial fibrillation?
Effect estimate: HR 1.57 (95% CI 1.14-2.17)
Absolute Event Rate: 2.5% vs 1.4%
p-value: p=0.005
Significant left atrial enlargement is present in a large proportion of patients with atrial fibrillation and is independently associated with an increased risk of stroke or systemic embolism, highlighting its utility in risk stratification.
May refine AF stroke risk stratification; leaves open incremental value beyond current scores in prospective data.
We sought to evaluate the clinical implication of LAE based on left atrial anterior-posterior (LA AP) dimension or LA volume index (LAVI) in Korean patients with atrial fibrillation (AF). We enrolled 8159 AF patients from the CODE-AF registry. The primary outcome was rate of stroke or systemic embolism (SSE). The prevalence of mild, moderate, and severe LAE by LA AP dimension was 30.6%, 18.5%, and 21.4%, and by LAVI (available in 5808 patients) was 15.7%, 12.5% and 37.8%, respectively. Compared with no or mild LAE, patients with significant LAE (moderate to severe LAE, n = 3258, 39.9%) were associated with a higher rate of SSE (2.5% vs. 1.4%, P = 0.001). Multivariable analysis suggested presence of significant LAE by LA AP dimension was associated with a higher risk of SSE in the overall population (HR 1.57, 95% CI: 1.14-2.17, P = 0.005) and in patients using anticoagulants (n = 5836, HR 1.79, 95% CI: 1.23-2.63, P = 0.002). Patients with significant LAE by LAVI were also at higher risk of SSE (HR 1.58, 95% CI: 1.09-2.29, P = 0.017). In conclusion, significant LAE by LA dimension or LAVI was present in 39.9% and 50.2% of AF patients, respectively, and was associated with a higher rate of SSE.
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Cho et al. (2021) conducted a cohort in Atrial fibrillation (n=8,159). Significant left atrial enlargement (moderate to severe) vs. No or mild left atrial enlargement was evaluated on Stroke or systemic embolism (SSE) (HR 1.57, 95% CI 1.14-2.17, p=0.005). Significant left atrial enlargement was associated with a higher risk of stroke or systemic embolism (HR 1.57) compared to no or mild enlargement in patients with atrial fibrillation.
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