Left atrial enlargement and stroke recurrence: the Northern Manhattan Stroke Study.

Abstract:

BACKGROUND AND PURPOSE:Although left atrial enlargement (LAE) increases incident stroke risk, the association with recurrent stroke is less clear. Our aim was to determine the association of LAE with recurrent stroke most likely related to embolism (cryptogenic and cardioembolic) and all ischemic stroke recurrences. METHODS:We followed 655 first ischemic stroke patients in the Northern Manhattan Stroke Study for ≤5 years. LA size from 2D echocardiography was categorized as normal LAE (52.7%), mild LAE (31.6%), and moderate-severe LAE (15.7%). We used Cox proportional hazard models to calculate the hazard ratios and 95% confidence intervals for the association of LA size and LAE with recurrent cryptogenic/cardioembolic and total recurrent ischemic stroke. RESULTS:LA size was available in 529 (81%) patients. Mean age at enrollment was 69±13 years; 45.8% were male, 54.0% Hispanic, and 18.5% had atrial fibrillation. Over a median of 4 years, there were 65 recurrent ischemic strokes (29 were cardioembolic or cryptogenic). In multivariable models adjusted for confounders, including atrial fibrillation and heart failure, moderate-severe LAE compared with normal LA size was associated with greater risk of recurrent cardioembolic/cryptogenic stroke (adjusted hazard ratio 2.83, 95% confidence interval 1.03-7.81), but not total ischemic stroke (adjusted hazard ratio 1.06, 95% confidence interval, 0.48-2.30). Mild LAE was not associated with recurrent stroke. CONCLUSION:Moderate to severe LAE was an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Further research is needed to determine whether anticoagulant use may reduce risk of recurrence in ischemic stroke patients with moderate to severe LAE.

journal_name

Stroke

journal_title

Stroke

authors

Yaghi S,Moon YP,Mora-McLaughlin C,Willey JZ,Cheung K,Di Tullio MR,Homma S,Kamel H,Sacco RL,Elkind MS

doi

10.1161/STROKEAHA.115.008711

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

1488-93

issue

6

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.115.008711

journal_volume

46

pub_type

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