European journal of internal medicine · 2026
Left atrial enlargement and 1-year cerebrovascular events in subjects without atrial fibrillation: A prospective cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Clerici Bianca, Casazza Giovanni, Russo Antonio, Massironi Laura, Moreo Antonella, Dadone Viola, Birocchi Simone, Bursi Francesca, Bonelli Andrea, Mattiello Paolo, Casanova Francesca, Pisetta Chiara, Scavone Mariangela, Guazzi Marco, Giannatasio Cristina, Pierini Simona, Agnelli Giancarlo, Podda Gian Marco
Аннотация
OBJECTIVES: Left atrial enlargement (LAE) is a cardiac structural abnormality linked to adverse cardiovascular events, including stroke. However, its independent prognostic role in patients without atrial fibrillation (AF) remains unclear.
DESIGN: prospective cohort study.
SETTING: three teaching hospitals in Milan, Italy.
PARTICIPANTS: consecutive adults undergoing transthoracic echocardiography (TTE) between 2012 and 2023. Patients with a history of AF or receiving anticoagulant therapy (for any indication) were excluded.
INTERVENTIONS: participants underwent TTE in the context of standard clinical practice.
MAIN OUTCOME MEASURES: LAE was categorized by left atrial volume index (LAVi) as absent (≤34 mL/m²), mild (>34 and ≤41 mL/m²), moderate (>41 and ≤48 mL/m²), or severe (>48 mL/m²). The primary outcome was a composite of cerebrovascular events (CVEs), including ischemic stroke or transient ischemic attack (TIA), within 1 year of the index echocardiogram. Multivariate logistic regression models were used to evaluate the independent association of LAE with 1-year CVEs.
RESULTS: We included 53,109 subjects with a median age of 66 years (48 % female). CVEs occurred in 1318 subjects (2.5 %). In the multivariate analysis, all categories of LAE were associated with 1-year CVEs compared with no LAE (mild: OR 1.21, 95 % CI 1.03 to 1.43; moderate: OR 1.48, 95 % CI 1.20 to 1.83; severe: OR 1.85, 95 % CI 1.54 to 2.22). This association was independent of other relevant predictors.
CONCLUSIONS: LAE defined by LAVi is associated with 1-year CVEs in subjects without known AF and ongoing anticoagulation, suggesting that LAVi can serve as a marker to refine CVE risk stratification.
DESIGN: prospective cohort study.
SETTING: three teaching hospitals in Milan, Italy.
PARTICIPANTS: consecutive adults undergoing transthoracic echocardiography (TTE) between 2012 and 2023. Patients with a history of AF or receiving anticoagulant therapy (for any indication) were excluded.
INTERVENTIONS: participants underwent TTE in the context of standard clinical practice.
MAIN OUTCOME MEASURES: LAE was categorized by left atrial volume index (LAVi) as absent (≤34 mL/m²), mild (>34 and ≤41 mL/m²), moderate (>41 and ≤48 mL/m²), or severe (>48 mL/m²). The primary outcome was a composite of cerebrovascular events (CVEs), including ischemic stroke or transient ischemic attack (TIA), within 1 year of the index echocardiogram. Multivariate logistic regression models were used to evaluate the independent association of LAE with 1-year CVEs.
RESULTS: We included 53,109 subjects with a median age of 66 years (48 % female). CVEs occurred in 1318 subjects (2.5 %). In the multivariate analysis, all categories of LAE were associated with 1-year CVEs compared with no LAE (mild: OR 1.21, 95 % CI 1.03 to 1.43; moderate: OR 1.48, 95 % CI 1.20 to 1.83; severe: OR 1.85, 95 % CI 1.54 to 2.22). This association was independent of other relevant predictors.
CONCLUSIONS: LAE defined by LAVi is associated with 1-year CVEs in subjects without known AF and ongoing anticoagulation, suggesting that LAVi can serve as a marker to refine CVE risk stratification.