Risk for systemic embolization of atrial fibrillation without mitral stenosis

Cabin, Henry S.; Clubb, K.Soni; Hall, Cynthia A.; Perlmutter, Robin A.; Feinstein, Alvan R.

doi:10.1016/0002-9149(90)90323-s

Cited by 174 publications

(91 citation statements)

References 37 publications

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“…In the arterial embolism, especially in the presence of underlying heart disease. The presence of the latter, including Framingham study, for example, the annual rate of stroke for patients in atrial fibrillation was approxivalvular heart disease, hypertensive heart disease, a dilated left atrium and poor left ventricular function, is mately 4% [16 ], which was comparable with those in two other studies: the Copenhagen AFASAK study and a significant risk factor for stroke and thromboembolism in atrial fibrillation [20,22]. For example, the thromthe Stroke Prevention in Atrial Fibrillation Study, where the annual incidence of stroke among placebo patients boembolic risk of atrial fibrillation is 18 times greater if rheumatic heart disease is present [23].…”

Section: Introductionsupporting

confidence: 59%

Warfarin and aspirin as thromboprophylaxis in atrial fibrillation

Lip

Lowe

1996

Brit J Clinical Pharma

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1Anticoagulant therapy with warfarin is now established as effective thromboprophylaxis against stroke in atrial fibrillation, in high‐risk persons. Aspirin is indicated in moderate‐risk persons or if warfarin is contraindicated. 2Risk stratification is suggested, using clinical factors supplemented by echocardiography, to aid choice of prophylaxis. 3Further studies are required to establish how best to identify undiagnosed patients who have atrial fibrillation; to develop new therapeutic strategies; and to refine risk stratification to define which patients with atrial fibrillation are at the highest risk of stroke.

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Section: Introductionsupporting

confidence: 59%

Warfarin and aspirin as thromboprophylaxis in atrial fibrillation

Lip

Lowe

1996

Brit J Clinical Pharma

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“…Further, LAVI predicted mortality independent of all LV geometric patterns and provided prognostic information incremental to other significant independent predictors of mortality. The association of LAE and mortality, both CV and all-cause, has been reported in a few population-based studies 6,9-11 as well as in several high-risk populations, such as patients with dilated cardiomyopathy, 19 LV dysfunction, 20 atrial arrhythmias, 21 and acute myocardial infarction. 22 Only a very few of these studies used LAVI, which is more accurate and reproducible, as a measure of LA size and were performed in a population with preserved LV systolic function as determined by LVEF.…”

Section: Discussionmentioning

confidence: 93%

Left Atrial Volume Index Predictive of Mortality Independent of Left Ventricular Geometry in a Large Clinical Cohort With Preserved Ejection Fraction

Patel¹,

Lavie²,

Milani³

et al. 2011

Mayo Clinic Proceedings

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Objective: To determine the effect on mortality of the left atrial volume index (LAVI) and left ventricular (LV) geometry (normal, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy). ReSultS: Progressive increases in LAVI and mortality were noted with abnormal LV geometry. Similarly, abnormal LV geometry and mortality were significantly higher in patients with increased LAVI.In patients who died vs surviving patients, the LAVI ± SD was significantly higher (33.0±14.8 vs 28.1±10.8 mL/m 2 ; P<.001) and abnormal LV geometry was significantly more prevalent (62% vs 44%; P<.001). Compared with those with a normal LAVI, patients with a severe LAVI had a 42% increased risk of mortality. In patients with normal LV geometry or concentric remodeling, a severe LAVI was a significant independent predictor of mortality, with an increased risk of 28% and 46%, respectively. Similarly, in patients with eccentric hypertrophy and concentric hypertrophy, the mortality risk in patients with a severe LAVI was twice that of patients with a normal LAVI. Comparison of area under the curve (0.565 [without LAVI] vs 0.596 [with LAVI]; P<.001] and predictive models with and without LAVI for mortality prediction were significant, indicating increased mortality prediction by the addition of LAVI to other independent predictors. cONcluSiON: The LAVI significantly predicts mortality risk, independent of LV geometry, and adds to the overall mortality prediction in a large cohort of patients with preserved systolic function. Mayo Clin © 2011 Mayo Foundation for Medical Education and ResearchL eft ventricular (LV) geometry, as an expression of the structural adaptation to an increased cardiovascular (CV) risk factor burden, is a well-known predictor of CV morbidity and mortality. [1][2][3][4][5] These structural changes in the left ventricle also lead to functional impairment, notably impaired LV filling, thereby facilitating the development of diastolic dysfunction 6 and ultimately leading to left atrial (LA) enlargement (LAE). 7 The left atrium is directly exposed to LV pressure during diastole through the open mitral valve, and therefore any morphologic changes in the left atrium are largely determined by the same factors that influence diastolic LV filling.8 Recent studies have shown that LA volume increases with the severity of diastolic dysfunction and may express long-term exposure to abnormal LV filling pressures, providing a more sensitive and stable morphophysiologic expression of LV diastolic dysfunction. 9Current evidence strongly suggests that LA size, as assessed by echocardiography, is strongly associated with mortality.7,10-12 However, it is still unknown whether LAE predicts mortality independent of LV geometry and also whether it provides additional prognostic information to that of other predictors of mortality in a large cohort of patients with preserved systolic function.To address this gap in the literature, we conducted a study of a large clinical cohort of 36,561 patients with preserved LV ejection ...

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“…[23][24][25][26] A large, prospective study, SPAF-I, also found that LA enlargement determined from transthoracic echocardiography related to a high risk for cerebral thromboembolism, 26 but a relationship between stroke and enlarged LA was not shown by other investigators. 17,27 In fact, pooled data from 3 prospective studies, BAATAF, SPAF-I and SPINAF, revealed that LA size determined by transthoracic echocardiography was not an independent risk.…”

Section: La Size and Embolismmentioning

confidence: 99%