Left atrial dimension and cardiovascular outcomes in patients with and without atrial fibrillation: a systematic review and meta-analysis

Abstract

ObjectiveThe prognostic value of left atrial (LA) dimensions may differ between patients with and without atrial fibrillation (AF).MethodsMEDLINE and EMBASE were searched for studies that investigated the association between LA echocardiographic parameters measured by transthoracic echocardiography and cardiovascular outcomes in patients with or without AF. Data were independently abstracted by two reviewers and pooled using random-effects meta-analysis. The primary outcome was incident stroke or thromboembolic events. Secondary outcomes were heart failure, all-cause mortality and major adverse cardiac events (MACE).ResultsTwenty-three studies of patients with AF (14 939 patients) and 68 studies of patients without AF (50 720 patients) in this systematic review. Increasing LA diameter was significantly associated with stroke and thromboembolic events in patients without AF (risk ratio (RR) 1.38, 95% CI 1.02 to 1.87; p=0.03), but not in patients with AF (RR 1.02, 95% CI 0.98 to 1.07; p=0.27; p for difference=0.05). Increasing LA diameter index was significantly associated with MACE in patients with AF (RR 1.13, 95% CI 1.09 to 1.17; p<0.001) and in patients without AF (RR 2.98, 95% CI 1.90 to 4.66; p<0.001), with stronger effects in non-AF populations (p for difference <0.001). Greater LA volume index was significantly associated with the risk of MACE in patients with AF (RR 1.01, 95% CI 1.00 to 1.02; p=0.03) and in non-AF populations (RR 1.08, 95% CI 1.05 to 1.10; p<0.001), the association being stronger in individuals without AF (p for difference <0.001).ConclusionsLarger LA parameters were associated with various adverse cardiovascular events. Many of these associations were stronger in individuals without AF, highlighting the potential importance of LA myopathy.

Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

“…[22][23][24] In healthy subjects, LAVI is not influenced by age, 25 is closely related to diastolic dysfunction, and is a powerful predictor of AF as well as other cardiovascular events. 26 In the absence of LVZs, patients with persistent AF undergoing PVI alone have clinical outcomes comparable to those with paroxysmal AF, 27 and, in a recent study, the efficacy of cryoballoon ablation in paroxysmal and persistent AF was equivalent when LAVI was less than 61 mL/m 2 . 28 Interestingly, LVZs detected by EAVM and the fibrotic content detected by LGE-MRI were associated with larger LA volume and were predictive of AF recurrence in paroxysmal as well as persistent AF.…”

“…LAVI provided a more accurate assessment of LA remodeling, and is known to be independently associated with AF recurrence after cardioversion or catheter ablation 22–24 . In healthy subjects, LAVI is not influenced by age, 25 is closely related to diastolic dysfunction, and is a powerful predictor of AF as well as other cardiovascular events 26 …”

Is left atrium the best kept secret of the heart? Left atrial dilatation and cardiovascular outcomes

“…The study by Froehlich et al ,2 published in Heart , provides a new insight into this important subject. This study presents a systematic review and a meta-analysis of 91 observational studies exploring the association between several indices of LA dilatation and outcomes in patients with AF (23 studies with a total of 14 936 participants) and those without AF (68 studies with a total of 50 720 patients).…”

“…Thus, LA dilatation appears to be a biomarker of left ventricular dysfunction, rather than a determinant of the future development of HF. This concept is challenged by the study by Froehlich et al ,2 suggesting an independent prognostic significance of LA dilatation for incident HF in patients with or without AF and a wide variety of associated cardiovascular disorders. In support of this observation, a recent study demonstrated that LAVI was an independent predictor of adverse cardiovascular outcomes, including HF, following first myocardial infarction 7.…”

Heartbeat: is the keyword ‘atrial’ or ‘fibrillation’?

“…However, it remains unclear whether this association is simply related to AF or whether LA size also is an important prognostic variable. In a meta-analysis of over 50 000 patients from studies that included patients with (n=23) or without (n=68) AF, Froehlich and colleagues1 found stronger associations between LA size and cardiovascular outcomes in patients without compared with those with AF (figure 1). For example, a larger LA diameter was significantly associated with stroke and thromboembolic events (risk ratio (RR) 1.38, 95% CI 1.02 to 1.87; p=0.03) in patients without AF, but not in those with AF (RR 1.02, 95% CI 0.98 to 1.07; p=0.27; p for difference=0.05).…”