Predictive value of echocardiographic left atrial size for incident stoke and stroke cause mortality: a population-based study

Abstract

ObjectivesTo investigate the associations between echocardiographic left atrial (LA) size and incident stoke and stroke cause mortality among a rural population in China.DesignA prospective study.Setting and participantsBased on the Northeast China Rural Cardiovascular Health Study, we selected a total of 10 041 participants aged ≥35 years who agreed to have transthoracic echocardiography at baseline and were successfully followed up for incident stoke and stroke cause mortality.Primary outcome measureThe outcomes were stroke and stroke cause death according to medical records and death certificates during the follow-up period.ResultsLA enlargement (LAE) group had a higher prevalence of cardiovascular disease than normal LA diameter (LAD) group. After excluding individuals who had a prior stroke, subjects with LAE showed higher incident rates of stroke and its mortality in the overall and specific stratified analyses (all p<0.05). Kaplan-Meier analysis revealed that LAE could predict stroke incidence and stroke-free survival, but the association was no longer observed after the adjustment for potential confounding factors. Cox regression analysis reported that per 1 SD increment in LAD and LAD/body surface area (BSA) was associated with an increased incidence of stroke (LAD: HR=1.20, 95% CI 1.08 to 1.33, p<0.001; LAD/BSA: HR=1.22, 95% CI 1.11 to 1.35, p<0.001) and stroke cause mortality (LAD: HR=1.27, 95% CI 1.08 to 1.50, p<0.01; LAD/BSA: HR=1.41, 95% CI 1.20 to 1.65, p<0.001) in the total population, and similar trends were found in both genders (all p<0.05). LAD or LAD/BSA was related to ischaemic and haemorrhagic stroke incidence, and the risk of ischaemic and haemorrhagic stroke mortality (all p<0.05). The dose–response curves further suggested linear associations between LAD, LAD/BSA and the incidence of stroke and subsequent mortality in the general population (all p<0.05).ConclusionsOur population-based study implied that LA size, especially LAD and LAD/BSA, might be useful echocardiographic biomarkers that had the potential to predict incident stroke and stroke cause mortality.

Atrial cardiomyopathy and incident ischemic stroke risk: a systematic review and meta-analysis

“…When analyzed as a categorical variable, the pooled results of five studies with 88,702 individuals [ 11 , 19 – 22 ] showed that a higher LA diameter was related to an increased risk of ischemic stroke (HR 1.39; 95% CI 1.06–1.82; I 2 = 72%) (Fig. 5 A).…”

The value of cardiopulmonary exercise testing and stress echocardiography in the prediction of all‐cause mortality in adults with end‐stage renal disease

“…LA size was also significantly smaller in survivors. Previous studies both in the general population (Li et al, 2021; Patel et al, 2015) and in ESRD participants (Patel et al, 2010; Tripepi et al, 2007) have shown LA size to be a significant predictor of adverse outcomes. As an easily, reliably, and reproducibly acquired measure using standard 2‐D echocardiography, routinely acquired LA size may provide further prognostic information in ESRD participants.…”

Cardiac imaging correlates and predictors of stroke in patients with atrial fibrillation: a meta-analysis

“…In fact, there is convincing evidence demonstrating that echocardiographic left atrial dimensions are predictors of major adverse cardiovascular events in patients both with and without atrial fibrillation. [88][89][90][91] Importantly, two studies showed that left atrial reservoir strain assessed by speckle-tracking echocardiography is independently associated with prior stroke or a predictor of incident stroke, 38,66 with a higher predictive value than the CHA 2 DS 2 VASc score, 38 indicating its potential value in improving current stroke risk stratification schemes. However, speckle-tracking analysis is challenging, especially during atrial fibrillation because of irregular cardiac cycles.…”