Prognostic Significance of Left Atrial Enlargement in a General Population

Abstract

Several studies have shown that alterations in left ventricular (LV) structure and function, such as an increased LV mass (LVM), a reduction of systolic contractility, and an impairment of LV diastolic function, have an adverse prognostic value (ie, that they are associated with an increased risk of cardiovascular morbid and fatal events, independently on other cardiovascular risk factors).1,2 More recently, evidence has been obtained that this is the case also for anatomic alterations of the left atrium (LA), the enlargement of which has been found to predict independently the development of heart failure, 3 and other cardiovascular events.4,5 LA enlargement, however, frequently occurs with an increased LVM or a frank LV hypertrophy (LVH), 6,7 both changes being commonly generated by an increase in blood pressure (BP), 8 and limited information exists on whether LA enlargement increases cardiovascular risk also when associated with or superimposed on LV structural changes.This has been the aim of the present study, which has examined the long-term risk of cardiovascular morbid and fatal events (as well as of all-cause mortality) in a population in which LA enlargement and LV hypertrophy were present in isolation or combination, their combined absence representing the control group. A strength of the study is that BP was measured in and outside the physician's office, which allowed to correct the data for the effect of BP elevation on cardiovascular risk more accurately than by using office BP. 9 Methods Subjects and MeasurementsThe details of the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study have been reported elsewhere.10 Briefly, the study was performed in 1990 to 1991 on 3200 individuals aged between 25 and 74 years, who were selected to be representative of the Monza population, based on the criteria of the World Health Organization Monitoring Diseases (WHO-MONICA) project performed in the same geographic area.11 The participation rate was 64%, and the demographic characteristics and medical history of nonparticipants were similar to those of participants. All subjects underwent a Abstract-We estimated the risk of cardiovascular events, cardiovascular mortality, and all-cause mortality associated with left atrium (LA) enlargement alone or combined with echocardiographic left ventricular hypertrophy (LVH) in 1785 representatives of the general population of Monza recruited for the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study. LA enlargement was assessed by measuring LA diameter via echocardiography. LA enlargement was defined as a LA diameter >2.3 cm/m 2 , whereas LVH was defined as a left ventricular mass index ≥114 g/m 2 and 99 g/m 2 in men and women, respectively. Death certificates and hospital diagnoses were collected over an average 148 months follow-up. During follow-up, there were 175 deaths (of which 59 for cardiovascular causes) and 139 cardiovascular fatal and nonfatal events. Compared with subjects with neither LA enlargement nor LVH, subjects with isolate...

Left Atrial Enlargement an Early Predictor for Development of Systolic Dysfunction – Results of a Cross-Sectional Study Conducted in Georgia

“…The role of LA volume as a marker for severity and as a significant independent predictor of LV diastolic dysfunction is well established [ According to the results of PAMELA study, which estimated the risk of cardiovascular events, cardiovascular mortality, and all-cause mortality associated with the LA enlargement alone or combined with echocardiographic LVH in 1,785 representatives of the general population, subjects with isolated LA enlargement exhibited a significant increase in the adjusted risk of combined fatal and nonfatal cardiovascular events [Bombelli M et al, 2014].…”

Left Atrial Size and Left Ventricular Mass Index in Hypertensive Patients

“…Multiple studies have shown that the left atrial enlargement is an independent long term predictor of cardiovascular events [10]. Although various factors like age, race, body mass index, duration of hypertension,valvular heart disease influence the left atrial size [11].…”

“…These findings are supported by the PAMELA study which showed that a LA diameter exhibited a significant direct relationship with several variables (age, LVM, body mass index and serum total cholesterol, triglycerides, and glucose) while showing a significant inverse relationship with few others (serum high-density lipoprotein cholesterol ). [10] …”

How to Identify Hypertensive Patients at High Cardiovascular Risk? The Role of Echocardiography

“…Moreover, LA size has been reported to be a strong predictor of death and heart failure hospitalization in patients with myocardial infarction and reduced LV ejection fraction [33,34]. Recently, the risk of cardiovascular events associated with LAE alone or combined with echocardiographic LVH has been estimated in 1,785 representatives of the general population of Monza recruited for the PAMELA study [35]. Compared with subjects with no LAE or LVH, subjects with isolated LAE exhibited a significant increase in adjusted risk of combined fatal and nonfatal cardiovascular events (hazard ratio 2.0; confidence interval 1.0-4.1; p = 0.04).…”