Left Atrial Size and Long‐Term Risk of Recurrent Stroke After Acute Ischemic Stroke in Patients With Nonvalvular Atrial Fibrillation. Issue 8 (15th August 2017)

• Record Type: Journal Article
• Authors: Ogata, Toshiyasu; Matsuo, Ryu; Kiyuna, Fumi; Hata, Jun; Ago, Tetsuro; Tsuboi, Yoshio; Kitazono, Takanari; Kamouchi, Masahiro
• Other Names: Ibayashi Setsuro investigator.; Kusuda Kenji investigator.; Fujii Kenichiro investigator.; Nagao Tetsuhiko investigator.; Okada Yasushi investigator.; Yasaka Masahiro investigator.; Ooboshi Hiroaki investigator.; Irie Katsumi investigator.; Omae Tsuyoshi investigator.; Nakane Hiroshi investigator.; Sugimori Hiroshi investigator.; Arakawa Shuji investigator.; Fukuda Kenji investigator.; Kitayama Jiro investigator.; Fujimoto Shigeru investigator.; Arihiro Shoji investigator.; Kuroda Junya investigator.; Wakisaka Yoshinobu investigator.; Fukushima Yoshihisa investigator.; Kumai Yasuhiro investigator.; Makihara Noriko investigator.; Takada Junichi investigator.
• Is Part Of: Journal of the American Heart Association. Volume 6:Issue 8(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-08-15
• Subjects: atrial fibrillation -- ischemic stroke -- left atrial diameter -- recurrent event; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.117.006402
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: Among patients with ischemic stroke and atrial fibrillation, which ones are at high risk of recurrent stroke is unclear. This study aimed to determine whether left atrial size was associated with long‐term risk of stroke recurrence in patients with nonvalvular atrial fibrillation. Methods and Results: In this multicenter prospective cohort study, nonvalvular atrial fibrillation patients hospitalized for acute ischemic stroke were enrolled and followed up after discharge. Indexed‐left atrial diameter was obtained by dividing left atrial diameter by body surface area. Cause‐specific and subdistribution hazard ratios of recurrent stroke were estimated by Cox proportional hazards and Fine–Gray models, respectively. Risk prediction was evaluated by integrated discrimination improvement and net reclassification improvement. In total, 1611 patients (77.8±10.2 [mean±SD] years, 44.5% female) were included. During follow‐up for 2.40±1.63 (mean±SD) years, 251 patients had recurrent stroke and 514 patients died. An increased indexed‐left atrial diameter (per 1 cm/m 2 ) was significantly associated with elevated risk of stroke recurrence (hazard ratio 1.60, 95% CI 1.30–1.98). The association was maintained when death was regarded as the competing risk and in 1464 patients who were treated with anticoagulants (hazard ratio 1.59, 95% CI 1.27–2.00). Risk prediction for recurrent stroke was significantly improved by adding indexed‐left atrial diameter to the baseline model composed of the factors in the CHADS2 score or those in the CHA2 DS2 ‐VASc score. Conclusion: These findings suggest that left atrial enlargement is associated with an increased risk of recurrent stroke in nonvalvular atrial fibrillation patients with ischemic stroke.