title: Left atrial enlargement and stroke recurrence: the Northern Manhattan Stroke Study.
abstract: OBJECTIVE
  Although left atrial enlargement (LAE) increases incident stroke risk, the association with recurrent stroke is less clear. Our aim was to determine the association of LAE with recurrent stroke most likely related to embolism (cryptogenic and cardioembolic) and all ischemic stroke recurrences.
  
  
  METHODS
  We followed 655 first ischemic stroke patients in the Northern Manhattan Stroke Study for ≤5 years. LA size from 2D echocardiography was categorized as normal LAE (52.7%), mild LAE (31.6%), and moderate-severe LAE (15.7%). We used Cox proportional hazard models to calculate the hazard ratios and 95% confidence intervals for the association of LA size and LAE with recurrent cryptogenic/cardioembolic and total recurrent ischemic stroke.
  
  
  RESULTS
  LA size was available in 529 (81%) patients. Mean age at enrollment was 69±13 years; 45.8% were male, 54.0% Hispanic, and 18.5% had atrial fibrillation. Over a median of 4 years, there were 65 recurrent ischemic strokes (29 were cardioembolic or cryptogenic). In multivariable models adjusted for confounders, including atrial fibrillation and heart failure, moderate-severe LAE compared with normal LA size was associated with greater risk of recurrent cardioembolic/cryptogenic stroke (adjusted hazard ratio 2.83, 95% confidence interval 1.03-7.81), but not total ischemic stroke (adjusted hazard ratio 1.06, 95% confidence interval, 0.48-2.30). Mild LAE was not associated with recurrent stroke.
  
  
  CONCLUSIONS
  Moderate to severe LAE was an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Further research is needed to determine whether anticoagulant use may reduce risk of recurrence in ischemic stroke patients with moderate to severe LAE.
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.). shadiyaghi@yahoo.com.
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors.forename: Yeseon P
authors.initials: YP
authors.lastname: Moon
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors.forename: Consuelo
authors.initials: C
authors.lastname: Mora-McLaughlin
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Willey
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors.forename: Ken
authors.initials: K
authors.lastname: Cheung
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: From the Department of Neurology, College of Physicians and Surgeons (S.Y., Y.P.M., C.M.-M.L., J.Z.W., M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (K.C.), Department of Internal Medicine, College of Physicians and Surgeons (M.R.D.T., S.H.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Neurology, Weill Cornell Medical College, New York, NY (H.K.); and Departments of Neurology, Public Health Sciences, Human Genetics, and Neurosurgery, Miller School of Medicine, University of Miami, FL (R.L.S.).
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D006332:Cardiomegaly / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009519:New York City / Q000453:epidemiology; D012008:Recurrence; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology
keywords: embolism