Association of computed tomography-derived left atrial size with major cardiovascular events in the general population: the Heinz Nixdorf Recall Study.
BACKGROUND
Echocardiography based data suggests that left atrial (LA) size is associated with cardiovascular morbidity and mortality. Once non-contrast cardiac CT is performed for prevention purposes, information on the LA is readily available. We aimed to determine whether LA area from non-contrast cardiac CT is associated with incident major cardiovascular (CV) events, independent of CV risk factors and coronary artery calcium (CAC), based on a general population cohort.


METHODS
Subjects aged 45-75 years without prevalent CV disease from the population-based Heinz Nixdorf Recall Study were enrolled between 2000 and 2003. LA area at the level of the mitral valve was quantified from non-contrast cardiac CT. Major CV events (coronary event, stroke, CV death) were assessed during follow-up. The association of LA with events was assessed using Cox regression analysis.


RESULTS
Overall, 3958 subjects (59.2 ± 7.7 years, 53% female) were included. Mean LA area was 17.64 ± 4.22 cm(2) (range: 7.16-44.13 cm(2)). During 8.0 ± 1.5 years of follow-up, 221 major CV events occurred. In univariate analysis, increase of LA size by 1 standard deviation was associated with nearly 50% excess events (HR (95%CI): 1.48 (1.32-1.65)), which remained significant after adjustment for CV risk factors (HR (95%CI): 1.25 (1.09-1.43)) and when additionally adjusting for CAC (HR (95%CI): 1.22 (1.07-1.40)). Associations for LA size were similar for each endpoint and again independent of risk factors and CAC (coronary event: HR (95%CI): 1.21 (1.01-1.45); stroke: 1.31 (1.05-1.63); CV death: 1.33 (1.03-1.71)).


CONCLUSIONS
LA size is associated with incident major CV events independent of risk factors and CAC-score. Once cardiac CT imaging is performed, assessment of LA size may complement information of this imaging modality.
West German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany. Electronic address: amir-abbas.mahabadi@uk-essen.de.
Amir A
AA
Mahabadi
Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Marie H
MH
Geisel
Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Nils
N
Lehmann
West German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
Christian
C
Lammerding
West German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
Hagen
H
Kälsch
West German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
Marcus
M
Bauer
Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Susanne
S
Moebus
Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Karl-Heinz
KH
Jöckel
West German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
Raimund
R
Erbel
West German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany; Krankenhaus Bethanien, Department of Cardiology, Moers, Germany.
Stefan
S
Möhlenkamp
D000368:Aged; D002114:Calcinosis / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
Computed tomography; Coronary artery calcium; Epidemiology; Heinz Nixdorf Recall Study; Left atrium