title: Left atrial size and risk for all-cause mortality and ischemic stroke.
abstract: BACKGROUND
  Limited data are available on the relation between left atrial size and outcome among patients referred for clinically indicated echocardiograms. Our aim was to assess the association of left atrial size with all-cause mortality and ischemic stroke in a large cohort of patients referred for echocardiography.
  
  
  METHODS
  Left atrial diameter was measured in 52 639 patients aged 18 years or older (mean age 61.8 [standard deviation (SD) 16.3] years; 52.9% men) who underwent a first transthoracic echocardiogram for clinical reasons at our institution between April 1990 and March 2008. The outcomes were all-cause mortality and nonfatal ischemic stroke.
  
  
  RESULTS
  Based on the criteria of the American Society of Echocardiography, 50.4% of the patients had no left atrial enlargement, whereas 24.5% had mild, 13.3% had moderate and 11.7% had severe left atrial enlargement. Over a mean follow-up period of 5.5 (SD 4.1) years, 12 527 patients died, and 2314 patients had a nonfatal ischemic stroke. Cumulative 10-year survival was 73.7% among patients with normal left atrial size, 62.5% among those with mild enlargement, 54.8% among those with moderate enlargement and 45% among those with severe enlargement (p < 0.001). After adjustment in multivariable Cox proportional hazard analysis, left atrial diameter remained a predictor of all-cause mortality in both sexes (hazard ratio [HR] per 1-cm increment in left atrial size 1.17, 95% confidence interval [CI] 1.12-1.22, p < 0.001 in women, and HR 1.09, 95% CI 1.05-1.13, p < 0.001 in men) and of ischemic stroke in women (HR 1.25, 95% CI 1.14-1.37, p < 0.001).
  
  
  CONCLUSIONS
  Left atrial diameter has a graded and independent association with all-cause mortality in both sexes and with ischemic stroke in women.
authors: Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain. alberto.bouzas.mosquera@sergas.es
authors: Alberto
authors: A
authors: Bouzas-Mosquera
authors: Francisco J
authors: FJ
authors: Broullón
authors: Nemesio
authors: N
authors: Álvarez-García
authors: Elizabet
authors: E
authors: Méndez
authors: Jesús
authors: J
authors: Peteiro
authors: Teresa
authors: T
authors: Gándara-Sambade
authors: Oscar
authors: O
authors: Prada
authors: Víctor X
authors: VX
authors: Mosquera
authors: Alfonso
authors: A
authors: Castro-Beiras
references: J Am Coll Cardiol. 2003 Oct 1;42(7):1199-205
references: 14522480
references: Am Heart J. 2008 Dec;156(6):1110-6
references: 19033006
references: Am Heart J. 2006 Feb;151(2):412-8
references: 16442908
references: J Am Soc Echocardiogr. 2003 Jul;16(7):777-802
references: 12835667
references: J Am Coll Cardiol. 2006 Mar 7;47(5):1018-23
references: 16516087
references: Mayo Clin Proc. 2004 Aug;79(8):1008-14
references: 15301328
references: Hypertension. 1995 Jun;25(6):1155-60
references: 7768556
references: Am J Cardiol. 2001 May 1;87(9):1051-7
references: 11348601
references: Circulation. 1994 Feb;89(2):724-30
references: 8313561
references: J Am Coll Cardiol. 2006 Jun 20;47(12):2357-63
references: 16781359
references: Am J Cardiol. 2002 Dec 15;90(12):1284-9
references: 12480035
references: Eur Heart J. 2007 Jul;28(14):1773-81
references: 17562673
references: Am J Cardiol. 2002 Mar 1;89(5):518-23
references: 11867034
references: Stroke. 2008 Oct;39(10):2701-6
references: 18658033
references: J Am Coll Cardiol. 2004 Jul 21;44(2):327-34
references: 15261927
references: Am J Cardiol. 1986 Feb 15;57(6):450-8
references: 2936235
references: J Am Coll Cardiol. 2003 Oct 1;42(7):1206-7
references: 14522481
references: Mayo Clin Proc. 2001 May;76(5):467-75
references: 11357793
references: J Am Coll Cardiol. 2005 Jan 4;45(1):87-92
references: 15629380
references: Circulation. 1998 Sep 8;98(10):946-52
references: 9737513
references: Am Heart J. 2008 Dec;156(6):1056-64
references: 19032999
references: J Am Coll Cardiol. 2007 Sep 25;50(13):1254-62
references: 17888843
references: Circulation. 2003 May 6;107(17):2207-12
references: 12695291
references: N Engl J Med. 2002 Nov 7;347(19):1505-11
references: 12421894
references: Stroke. 1999 Oct;30(10):2019-24
references: 10512901
references: J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63
references: 16376782
references: Arch Intern Med. 2005 Aug 8-22;165(15):1788-93
references: 16087829
references: Am J Cardiol. 1995 Aug 15;76(5):355-8
references: 7639159
references: Circulation. 1995 Aug 15;92(4):835-41
references: 7641364
references: J Am Coll Cardiol. 2002 Oct 16;40(8):1425
references: 12392832
references: Am J Cardiol. 1999 Oct 1;84(7):829-32
references: 10513783
references: Circulation. 1997 Oct 7;96(7):2455-61
references: 9337224
references: Circulation. 1978 Dec;58(6):1072-83
references: 709763
references: Am J Cardiol. 2004 Sep 15;94(6):760-3
references: 15374781
references: Am J Cardiol. 2006 Oct 1;98(7):960-5
references: 16996883