title: Left atrial enlargement is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial fibrillation.
abstract: Controversy exists regarding whether left atrial enlargement (LAE) is a predictor of stroke/systemic embolism (SE) in atrial fibrillation (AF) patients. The Fushimi AF Registry, a community-based prospective survey, enrolled all AF patients in Fushmi-ku, Japan, from March 2011. Follow-up data and baseline echocardiographic data were available for 2,713 patients by August 2015. We compared backgrounds and incidence of events over a median follow-up of 976.5 days between patients with LAE (left atrial diameter > 45 mm; LAE group) and those without in the Fushimi AF Registry. The LAE group accounted for 39% (n = 1,049) of cohort. The LAE group was older and had longer AF duration, with more prevalent non-paroxysmal AF, higher CHADS2/CHA2DS2-VASc score, and oral anticoagulant (OAC) use. A higher risk of stroke/SE during follow-up in the LAE group was found (entire cohort; hazard ratio (HR): 1.92, 95% confidence interval (CI): 1.40-2.64; p < 0.01; without OAC; HR: 1.97, 95% CI: 1.18-3.25; p < 0.01; with OAC; HR: 1.83, 95% CI: 1.21-2.82; p < 0.01). LAE was independently associated with increased risk of stroke/SE (HR: 1.74, 95% CI: 1.25-2.42; p < 0.01) after adjustment by the components of CHA2DS2-VASc score and OAC use. In conclusion, LAE was an independent predictor of stroke/SE in large community cohort of AF patients.
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hamatani
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takabayashi
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takagi
authors.affiliation: Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Esato
authors.affiliation: Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan.
authors.forename: Yeong-Hwa
authors.initials: YH
authors.lastname: Chun
authors.affiliation: Tsuji Clinic, Kyoto, Japan.
authors.forename: Hikari
authors.initials: H
authors.lastname: Tsuji
authors.affiliation: Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Wada
authors.affiliation: Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Akao
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D004452:Echocardiography; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology