title: Relation of female sex to left atrial diameter and cardiovascular death in atrial fibrillation: The AFFIRM Trial.
abstract: BACKGROUND
  Female sex is associated with thromboembolism related to atrial fibrillation (AF). Left atrial (LA) diameter independently predicted incident cardiovascular (CV) major events in the general population. In AF patients, LA enlargement is associated to AF occurrence and recurrence. No data have previously been reported on the relationship between LA enlargement, sex and CV death in AF patients.
  
  
  RESULTS
  All patients enrolled in the AFFIRM Trial with available data about LA dimension were included in this post-hoc analysis. Of the 2615 eligible for the present analysis, LA enlargement was recorded in 67.0%, more commonly in women than in men (p=0.032). Patients with LA enlargement had higher body mass index (BMI), and were more frequently hypertensive, diabetic, and diagnosed with a structural heart disease, prior coronary artery disease (CAD) and heart failure (HF). BMI, left ventricular mass, female sex and mitral valve insufficiency (p<0.001) were associated with LA enlargement. AF female patients with LA enlargement had a higher risk for CV death (p=0.011). LA diameter showed a significant association with CV death (p<0.001). Cox regression analysis demonstrated that LA diameter was an independent predictor of CV death in female AF patients (p=0.003).
  
  
  CONCLUSIONS
  LA diameter enlargement is associated with female sex, and carries a higher risk for CV death, particularly in females. LA diameter was an independent predictor of CV death in female AF patients.
authors.affiliation: University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom. Electronic address: marco.proietti@uniroma1.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Proietti
authors.affiliation: I Clinica Medica, Sapienza-University of Rome, Rome, Italy; Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza-University of Rome, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Raparelli
authors.affiliation: I Clinica Medica, Sapienza-University of Rome, Rome, Italy; Research Center on Gender and Evaluation and Promotion of Quality in Medicine (CEQUAM), Sapienza-University of Rome, Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Basili
authors.affiliation: Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Olshansky
authors.affiliation: University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: g.y.h.lip@bham.ac.uk.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000401:mortality*; D003643:Death; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D006984:Hypertrophy; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D015996:Survival Rate / Q000639:trends
keywords: Atrial fibrillation; Cardiovascular death; Left atrium; Women