Elsevier

American Heart Journal

Volume 151, Issue 2, February 2006, Pages 412-418
American Heart Journal

Clinical Investigation
Imaging and Diagnostic Testing
Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: The Strong Heart Study (SHS)

https://doi.org/10.1016/j.ahj.2005.04.031Get rights and content

Background

Echocardiographic left atrial (LA) volume has been documented to be an independent predictor of cardiovascular events. Less is known about the predictive ability of anteroposterior LA diameter, a simpler measure of LA size obtained routinely during echocardiographic evaluation.

Methods

We investigated the prognostic value of LA diameter for incident cardiovascular events in 2804 American Indians free of clinical cardiovascular disease, valvular disease, and atrial fibrillation. Echocardiographic variables were obtained using standardized methods, and previously derived sex-specific partition values were used to define left ventricular (LV) hypertrophy indexed to height2.7 (in meters) and LA enlargement (>4.2 cm in men, >3.8 cm in women). Cardiovascular events included nonfatal stroke, coronary heart disease, congestive heart failure, and fatal cardiovascular disease based on validated definitions.

Results

During a median follow-up of 7 years, 368 events occurred. LA diameter, both as a continuous and as a categorical variable, was significantly associated with incident cardiovascular events in unadjusted analyses. In multivariable analyses that adjusted for age, sex, body mass index, hypertension, diabetes, total cholesterol–high-density lipoprotein cholesterol, smoking, renal insufficiency, LV hypertrophy, abnormal LV systolic and diastolic function, mitral annular calcification, fibrinogen, and C-reactive protein, both LA diameter (risk ratio 1.04/mm, 95% CI 1.02-1.07, P < .002) and LA enlargement (risk ratio 1.57, 95% CI 1.17-2.10, P = .002) remained independent predictors of first cardiovascular events.

Conclusions

In this population-based cohort, LA diameter independently predicted incident cardiovascular events after adjustment for established clinical, echocardiographic, and inflammatory risk factors. This simple measure of LA dilatation can identify individuals at heightened risk who may warrant more aggressive risk factor modification.

Section snippets

Participants

The SHS is a population-based survey of risk factors for cardiovascular morbidity and mortality in 13 American Indian communities in Arizona, Oklahoma, South Dakota, and North Dakota.14, 15 Tribal members aged 45 to 74 years were recruited from all eligible individuals for an initial examination between July 1989 and January 1992. Baseline assessment of subjects included standardized measurement of seated blood pressure, aspects of body habitus, and fasting glucose, creatinine, lipid, and

Results

Clinical and echocardiographic characteristics of the study cohort are presented in Table I. Approximately one sixth of subjects had LA enlargement, and these individuals were older than those with normal LA diameter and were more often women. They also had a greater mean body mass index and, with the exception of smoking and total cholesterol/HDL-C, a higher prevalence of every traditional risk factor assessed than those with normal atria. Similarly, they exhibited greater frequencies of LV

Discussion

In this population-based cohort of middle-aged and elderly adults free of clinical cardiovascular disease, LA diameter proved to be an independent risk factor for incident cardiovascular events. This relationship was observed both when LA diameter was considered continuously, and when it was dichotomized based on previously derived sex-specific partition values.20 Importantly, LA diameter was 1 of 3 independent echocardiographic predictors of cardiovascular events, along with LV mass index and

References (35)

  • L.E. Teichholz et al.

    Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy

    Am J Cardiol

    (1976)
  • C.P. Appleton et al.

    Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease

    J Am Coll Cardiol

    (1993)
  • T.S.M. Tsang et al.

    Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden

    Am J Cardiol

    (2002)
  • C.L. Simek et al.

    Relationship between left ventricular wall thickness and left atrial size: comparison with other measures of diastolic function

    J Am Soc Echocardiogr

    (1995)
  • T. Yamada et al.

    Prediction of paroxysmal atrial fibrillation in patients with congestive heart failure: a prospective study

    J Am Coll Cardiol

    (2000)
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults

    Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

    JAMA

    (2001)
  • P.M. Ridker et al.

    C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women

    N Engl J Med

    (2000)
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    This study was supported by grants U01-HL41642, U01-HL41652, and U01-HL41654; by Career Development Award K23-HL070854 (Dr Kizer) from the National Heart, Lung, and Blood Institute, Bethesda, MD; and by grant M10RR0047 (GCRC) from the National Institutes of Health, Bethesda, Md.

    The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the Indian Health Service.

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