title: Relation of left atrial dysfunction to ischemic stroke in patients with coronary heart disease (from the heart and soul study).
abstract: This study sought to determine whether left atrial (LA) dysfunction independently predicts ischemic stroke. Atrial fibrillation (AF) impairs LA function and is associated with ischemic stroke. However, ischemic stroke frequently occurs in patients without known AF. The direct relation between LA function and risk of ischemic stroke is unknown. We performed transthoracic echocardiography at rest in 983 subjects with stable coronary heart disease. To quantify LA dysfunction, we used the left atrial function index (LAFI), a validated formula incorporating LA volumes at end-atrial systole and diastole. Cox proportional hazards models were used to evaluate the association between LAFI and ischemic stroke or transient ischemic attack (TIA). Over a mean follow-up of 7.1 years, 58 study participants (5.9%) experienced an ischemic stroke or TIA. In patients without known baseline AF or warfarin therapy (n = 893), participants in the lowest quintile of LAFI had >3 times the risk of ischemic stroke or TIA (hazard ratio 3.3, 95% confidence interval 1.1 to 9.7, p = 0.03) compared with those in the highest quintile. For each standard deviation (18.8 U) decrease in LAFI, the hazard of ischemic stroke or TIA increased by 50% (hazard ratio 1.5, 95% confidence interval 1.0 to 2.1, p = 0.04). Among measured echocardiographic indexes of LA function, including LA volume, LAFI was the strongest predictor of ischemic stroke or TIA. In conclusion, LA dysfunction is an independent risk factor for stroke or TIA, even in patients without baseline AF.
authors.affiliation: Doris Duke Clinical Research Fellowship Program, University of California, San Francisco, California; Department of Medicine, California Pacific Medical Center, San Francisco, California.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Wong
authors.affiliation: Veterans Affairs Medical Center, San Francisco, California; Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Christine C
authors.initials: CC
authors.lastname: Welles
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California.
authors.forename: Farnaz
authors.initials: F
authors.lastname: Azarbal
authors.affiliation: Veterans Affairs Medical Center, San Francisco, California; Department of Medicine, University of California, San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
authors.affiliation: Veterans Affairs Medical Center, San Francisco, California; Division of Cardiology, University of California, San Francisco, San Francisco, California.
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California. Electronic address: mintu@stanford.edu.
authors.forename: Mintu P
authors.initials: MP
authors.lastname: Turakhia
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016279:Atrial Function, Left / Q000502:physiology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002140:California / Q000453:epidemiology; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors