Left Atrial Size and Ischemic Events after Ischemic Stroke or Transient Ischemic Attack in Patients with Nonvalvular Atrial Fibrillation.
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Tokunaga Keisuke, Koga Masatoshi, Yoshimura Sohei, Okada Yasushi, Yamagami Hiroshi, Todo Kenichi, Itabashi Ryo, Kimura Kazumi, Sato Shoichiro, Terasaki Tadashi, Inoue Manabu, Shiokawa Yoshiaki, Takagi Masahito, Kamiyama Kenji, Tanaka Kanta, Takizawa Shunya, Shiozawa Masayuki, Okuda Satoshi, Kameda Tomoaki, Nagakane Yoshinari, Hasegawa Yasuhiro, Shibuya Satoshi, Ito Yasuhiro, Matsuoka Hideki, Takamatsu Kazuhiro, Nishiyama Kazutoshi, Kario Kazuomi, Yagita Yoshiki, Mizoguchi Tadataka, Fujita Kyohei, Ando Daisuke, Kumamoto Masaya, Miwa Kaori, Arihiro Shoji, Toyoda Kazunori, for the SAMURAI Study Investigators
Аннотация
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.