Left atrial size and risk of recurrent ischemic stroke in a Chinese population.

Jie Xue,Xiaoli Chen,Yuansheng Ye,Qian Li,Wanli Zhang,Yuanshao Lin,Bei Shao,Wensi Huang,Zhengyi Cai

doi:10.1002/brb3.702

Abstract

BackgroundAlthough a number of studies have reported the role of an increased left atrial (LA) size on stroke, limited data are collected about the relationship between LA enlargement and recurrent ischemic stroke in the Chinese population. Our aim was to assess the association of LA size with the risk of stroke recurrence, particularly with recurrent cardioembolic or cryptogenic stroke in ischemic stroke patients.MethodsThe study recruited 313 consecutive patients with acute first‐ever ischemic stroke. Echocardiographic LA diameter was measured and indexed by height and body surface area separately. The endpoint was recurrent ischemic stroke. Cox proportional hazard models were used to examine the association of LA size with total recurrent ischemic stroke and recurrent cardioembolic or cryptogenic stroke while adjusting for baseline demographics characteristics, clinical factors, echocardiographic left ventricular ejection fraction, and medication.ResultsOver a median follow‐up period of 1.63 years, 47 recurrent ischemic strokes (21 were cardioembolic or cryptogenic) occurred. In a multivariate model adjusted for potential confounders, compared with the bottom tertiles of LA diameter indexed to height (LA diameter/H), the top tertile of LA diameter/H was significantly associated with the total recurrent ischemic stroke (adjusted HR 3.610, 95% CI 1.870–6.967, p < .001) and the composite of recurrent cardioembolic or cryptogenic stroke (adjusted HR 5.673, 95% CI 1.780–18.084, p = .003). Results were similar when LA diameter indexed to body surface area (LA diameter/BSA) was involved in the analysis.Conclusion LA size is an independent predictor of total recurrent ischemic stroke and the composite of recurrent cardioembolic or cryptogenic stroke.

Highlights

Stroke is the second leading cause of death in the world (Johnston, Mendis, & Mathers, 2009) but is the first cause of death and adult disability in China (Liu, Wang, Wong, & Wang, 2011)
left atrial (LA) diameter/H was associated with recurrent ischemic stroke in the unadjusted model and in the multivariable model adjusting for age, sex, hypertension, diabetes mellitus, hypercholesterolemia, atrial fibrillation, smoking, left ventricular (LV) ejection fraction, and the use of antiplatelet and anticoagulation agents
This relationship persisted after adjusting for age, sex, hypertension, diabetes mellitus, hypercholesterolemia, atrial fibrillation, smoking, LV ejection fraction, and the use of antiplatelet and anticoagulation agents

Summary

| INTRODUCTION

Stroke is the second leading cause of death in the world (Johnston, Mendis, & Mathers, 2009) but is the first cause of death and adult disability in China (Liu, Wang, Wong, & Wang, 2011). A number of studies performed in the general population have evaluated the relationship between left atrial size and stroke, but the conclusions vary (Barnes et al, 2004; Benjamin, D’Agostino, Belanger, Wolf, & Levy, 1995; Bouzas-Mosquera et al, 2011; Di Tullio, Sacco, Sciacca, & Homma, 1999; Gardin et al, 2001; Kizer et al, 2006; Nagarajarao et al, 2008). In a recent prospective study, moderate to severe LA enlargement was found to be associated with the risk of recurrent cardioembolic and cryptogenic stroke, suggesting that these two stroke subtypes may share a common embolic mechanism (Yaghi et al, 2015). We hypothesized that echocardiographic LA size would be associated with recurrent ischemic stroke, especially with cardioembolic and cryptogenic stroke

| METHODS

Findings

| DISCUSSION