Left Atrial Enlargement and the Risk of Stroke: A Meta-Analysis of Prospective Cohort Studies

Xu, Yicheng; Zhao, Liming; Zhang, Lvming; Han, Yaling; Wang, Peifu; Yu, Shengyuan

doi:10.3389/fneur.2020.00026

Cited by 37 publications

(30 citation statements)

References 28 publications

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“…First, we were able to replicate previous observations demonstrating associations between greater LA volume and cardiovascular diseases [7][8][9][10]19,20 . Participants with a history of AF had larger LA volumes; and participants with larger LA volumes were more likely to be subsequently diagnosed with AF, stroke, or heart failure.…”

Section: Discussionsupporting

confidence: 74%

“…Enlargement of left atrial (LA) volumes is commonly observed with hypertension 7 , heart failure 8 , or after a diagnosis of AF 9,10 -and AF plays a causal role in this process 11 . Enlargement of the LA and decreased LA function have also been identified as independent risk factors for AF 10,[12][13][14][15][16][17] and stroke [18][19][20] . Together these atrial structural, contractile, or electrophysiological changes that have clinical consequences have been termed atrial cardiomyopathies 21,22 .…”

Section: Introductionmentioning

confidence: 99%

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Deep Learning of Left Atrial Structure and Function Provides Link to Atrial Fibrillation Risk

Achille

Choi

Khurshid

et al. 2021

Preprint

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Aims: Increased left atrial (LA) volume is a known risk factor for atrial fibrillation (AF). There is also emerging evidence that alterations in LA function due to an atrial cardiomyopathy are associated with an increased risk of AF. The availability of large-scale cardiac MRI data paired with genetic data provides a unique opportunity to assess the joint genetic contributions of LA structure and function to AF risk. Methods and results: We developed deep learning models to measure LA traits from cardiovascular magnetic resonance imaging (MRI) in 40,558 UK Biobank participants and integrated these data to estimate LA minimum (LAmin), maximum (LAmax), and stroke volume (LASV), as well as emptying fraction (LAEF). We conducted a genome-wide association study (GWAS) in 35,049 participants without pre-existing cardiovascular disease, identifying 20 common genetic loci associated with LA traits. Eight of the loci associated with LA traits were previously associated with AF: the AF risk alleles were associated with an increased LA minimum volume (LAmin) and a decreased LAEF. A Mendelian randomization analysis confirmed that AF causally affects LA volume (IVW P = 6.2E-06), and provided evidence that LAmin causally affects AF risk (IVW P = 4.7E-05). In UK Biobank participants, a polygenic prediction of LAmin was significantly associated with risk for AF (HR 1.09 per SD; P = 1.6E-36) and ischemic stroke (HR 1.04 per SD; P = 4.7E-03). Conclusions: We performed the largest and highest resolution assessment of LA structure and function to date. We then identified 20 common genetic variants associated with LA volumes or LAEF, 19 of which were novel. We found that a polygenic prediction of the minimal LA volume was associated with AF and stroke. Finally, we found an inverse relation between genetic variants associated with AF risk and LAEF. Our findings provide evidence of a causal relation between LA contractile function and AF. Keywords: Left atrium, machine learning, cardiovascular disease, genetics, atrial fibrillation

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Deep Learning of Left Atrial Structure and Function Provides Link to Atrial Fibrillation Risk

Achille

Choi

Khurshid

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…We defined the cutoff value of LA enlargement as LA diameter more than 50 mm, as LA diameter more than 50 mm had been previously reported to be associated with a higher risk of stroke and systemic embolization in patients with AF ( 11 ). Besides, in our study the LA size was not controlled for body size because it did not significantly affect the results and it has been reported that LA size not controlled for body size was associated with an increased risk of stroke in patients with AF ( 17 ).…”

Section: Methodsmentioning

confidence: 85%

Correlation Between CHA2DS2-VASc Score and Left Atrial Size in Patients With Atrial Fibrillation: A More Than 15-Year Prospective Follow-Up Study

Tsai

Huang

Chen

et al. 2021

Front. Cardiovasc. Med.

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Background: Left atrial (LA) size represents atrial fibrillation (AF) burden and has been shown to be a predictor for AF stroke. The CHA2DS2-VASc score is also a well-established predictor of AF stroke. It is unknown to cardiologists whether these two risk scores are correlated, whether both are independent prognostic predictors and complimentary to each other, or whether one of them is a major determinant of stroke risk for AF patients.Method: A total of 708 patients from the National Taiwan University Atrial Fibrillation Registry were longitudinally followed up for more than 15 years. Left atrial size was measured by M mode of echocardiography. Adverse thromboembolic endpoints during follow-up were defined as ischemic stroke or transient ischemic attack.Results: The mean age was 72.1 ± 12.9 years, with 53% men. Both LA size and CHA2DS2-VASc score were associated with the risk of stroke in univariate analyses. There was a weak but significant positive correlation between LA size and CHA2DS2-VASc score (r = 0.17, P < 0.0001). Patients with higher CHA2DS2-VASc scores had a higher mean LA size (P < 0.01 for trend). When combining LA size and CHA2DS2-VASc score in the multivariable Cox model, only CHA2DS2-VASc score remained statistically significant [HR 1.39 (1.20–1.63); P < 0.001].Conclusion: LA size is not an independent predictor of AF stroke, and calculation of CHA2DS2-VASc score may be an alternative to measurement of echocardiographic LA size when evaluating the risk of stroke for AF patients.

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“… 26 A recent systematic review involving six cohorts concluded that LAE was related to an increased and graded risk of stroke independent of age, sex, hypertension and diabetes. 2 In our study, when LAD was dichotomised based on sex-specific partition values, subjects with LAE exhibited elevated incident rates of stroke and its mortality in the overall and stratified comparisons. The Kaplan-Meier curves revealed that LAE was significantly associated with higher stroke incidence in male, female and ischaemic subtype, as well as worse stroke-free survival in male and ischaemic stroke.…”

Section: Discussionmentioning

confidence: 64%

Predictive value of echocardiographic left atrial size for incident stoke and stroke cause mortality: a population-based study

Guo

et al. 2021

BMJ Open

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ObjectivesTo investigate the associations between echocardiographic left atrial (LA) size and incident stoke and stroke cause mortality among a rural population in China.DesignA prospective study.Setting and participantsBased on the Northeast China Rural Cardiovascular Health Study, we selected a total of 10 041 participants aged ≥35 years who agreed to have transthoracic echocardiography at baseline and were successfully followed up for incident stoke and stroke cause mortality.Primary outcome measureThe outcomes were stroke and stroke cause death according to medical records and death certificates during the follow-up period.ResultsLA enlargement (LAE) group had a higher prevalence of cardiovascular disease than normal LA diameter (LAD) group. After excluding individuals who had a prior stroke, subjects with LAE showed higher incident rates of stroke and its mortality in the overall and specific stratified analyses (all p<0.05). Kaplan-Meier analysis revealed that LAE could predict stroke incidence and stroke-free survival, but the association was no longer observed after the adjustment for potential confounding factors. Cox regression analysis reported that per 1 SD increment in LAD and LAD/body surface area (BSA) was associated with an increased incidence of stroke (LAD: HR=1.20, 95% CI 1.08 to 1.33, p<0.001; LAD/BSA: HR=1.22, 95% CI 1.11 to 1.35, p<0.001) and stroke cause mortality (LAD: HR=1.27, 95% CI 1.08 to 1.50, p<0.01; LAD/BSA: HR=1.41, 95% CI 1.20 to 1.65, p<0.001) in the total population, and similar trends were found in both genders (all p<0.05). LAD or LAD/BSA was related to ischaemic and haemorrhagic stroke incidence, and the risk of ischaemic and haemorrhagic stroke mortality (all p<0.05). The dose–response curves further suggested linear associations between LAD, LAD/BSA and the incidence of stroke and subsequent mortality in the general population (all p<0.05).ConclusionsOur population-based study implied that LA size, especially LAD and LAD/BSA, might be useful echocardiographic biomarkers that had the potential to predict incident stroke and stroke cause mortality.

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Left Atrial Enlargement and the Risk of Stroke: A Meta-Analysis of Prospective Cohort Studies

Cited by 37 publications

References 28 publications

Deep Learning of Left Atrial Structure and Function Provides Link to Atrial Fibrillation Risk

Deep Learning of Left Atrial Structure and Function Provides Link to Atrial Fibrillation Risk

Correlation Between CHA2DS2-VASc Score and Left Atrial Size in Patients With Atrial Fibrillation: A More Than 15-Year Prospective Follow-Up Study

Predictive value of echocardiographic left atrial size for incident stoke and stroke cause mortality: a population-based study

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