Left Atrial Size and Ischemic Events after Ischemic Stroke or Transient Ischemic Attack in Patients with Nonvalvular Atrial Fibrillation.

Abstract

BACKGROUND:

The present study aimed to clarify the association between left atrial (LA) size and ischemic events after ischemic stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF).

METHODS:

Acute ischemic stroke or TIA patients with NVAF were enrolled. LA size was classified into normal LA size, mild LA enlargement (LAE), moderate LAE, and severe LAE. The ischemic event was defined as ischemic stroke, TIA, carotid endarterectomy, carotid artery stenting, acute coronary syndrome or percutaneous coronary intervention, systemic embolism, aortic aneurysm rupture or dissection, peripheral artery disease requiring hospitalization, or venous thromboembolism.

RESULTS:

A total of 1,043 patients (mean age, 78 years; 450 women) including 1,002 ischemic stroke and 41 TIA were analyzed. Of these, 351 patients (34%) had normal LA size, 298 (29%) had mild LAE, 198 (19%) had moderate LAE, and the remaining 196 (19%) had severe LAE. The median follow-up duration was 2.0 years (interquartile range, 0.9-2.1). During follow-up, 117 patients (11%) developed at least one ischemic event. The incidence rate of total ischemic events increased with increasing LA size. Severe LAE was independently associated with increased risk of ischemic events compared with normal LA size (multivariable-adjusted hazard ratio, 1.75; 95% confidence interval, 1.02-3.00).

CONCLUSION:

Severe LAE was associated with increased risk of ischemic events after ischemic stroke or TIA in patients with NVAF.

• Authors: Keisuke Tokunaga, Masatoshi Koga, Sohei Yoshimura, Yasushi Okada, Hiroshi Yamagami, Kenichi Todo, Ryo Itabashi, Kazumi Kimura, Shoichiro Sato, Tadashi Terasaki, Manabu Inoue, Yoshiaki Shiokawa, Masahito Takagi, Kenji Kamiyama, Kanta Tanaka, Shunya Takizawa, Masayuki Shiozawa, Satoshi Okuda, Tomoaki Kameda, Yoshinari Nagakane, Yasuhiro Hasegawa, Satoshi Shibuya, Yasuhiro Ito, Hideki Matsuoka, Kazuhiro Takamatsu, Kazutoshi Nishiyama, Kazuomi Kario, Yoshiki Yagita, Tadataka Mizoguchi, Kyohei Fujita, Daisuke Ando, Masaya Kumamoto, Kaori Miwa, Shoji Arihiro, Kazunori Toyoda, for the SAMURAI Study Investigators
• Journal: Cerebrovascular diseases (Basel, Switzerland) (Cerebrovasc Dis) Vol. 49 Issue 6 Pg. 619-624 ( 2020) ISSN: 1421-9786 [Electronic] Switzerland
• PMID: 33176314 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 S. Karger AG, Basel.

Topics

• Aged
• Aged, 80 and over
• Atrial Fibrillation (diagnostic imaging, epidemiology, physiopathology)
• Atrial Function, Left
• Atrial Remodeling
• Echocardiography
• Female
• Heart Atria (diagnostic imaging, physiopathology)
• Humans
• Incidence
• Ischemic Attack, Transient (diagnostic imaging, epidemiology, physiopathology)
• Ischemic Stroke (diagnostic imaging, epidemiology, physiopathology)
• Japan (epidemiology)
• Male
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Risk Assessment
• Risk Factors