Di Tullio M R, Sacco R L, Sciacca R R, Homma S
Department of Medicine, Columbia-Presbyterian Medical Center, New York, NY, USA.
Stroke. 1999 Oct;30(10):2019-24. doi: 10.1161/01.str.30.10.2019.
The association between left atrial size and ischemic stroke is controversial and has been suggested to exist only in men and to be mediated by left ventricular mass. Data are available almost exclusively for white patients. The purpose of this study was to evaluate the association between left atrial size and ischemic stroke in a multiethnic population.
A population-based case-control study was conducted in 352 patients aged >39 years with first ischemic stroke and in 369 age-, gender-, and race-ethnicity-matched community controls. Left atrial diameter was measured by 2-dimensional transthoracic echocardiography and indexed by body surface area. Conditional logistic regression analysis was performed to assess the risk of stroke associated with left atrial index in the overall group and in the age, gender, and race-ethnic strata after adjustment for the presence of other stroke risk factors.
Left atrial index was associated with ischemic stroke in the overall group (adjusted OR 1.47 per 10 mm/1.7 m(2) of body surface area; 95% CI 1.03 to 2.11). The association was present in men (adjusted OR 2.81, 95% CI 1.42 to 5.57) but not in women (adjusted OR 1.08, 95% CI 0.70 to 1.66), and in patients aged <60 years (adjusted OR 3.78, 95% CI 1.36 to 10.54) but not >60 years (adjusted OR 1.23, 95% CI 0.84 to 1.81). Subgroup analyses showed the risk to be present in men across all age subgroups. In women, the lack of association between left atrial index and stroke was most strongly influenced by left ventricular hypertrophy. A trend toward an association between left atrial index and stroke was observed in whites (adjusted OR 1.81, 95% CI 0.81 to 4.09) and Hispanics (adjusted OR 1.61, 95% CI 0.98 to 2.65) but was less evident in blacks (adjusted OR 1.25, 95% CI 0.74 to 2.14).
Left atrial enlargement is associated with an increased risk of ischemic stroke after adjustment for other stroke risk factors, including left ventricular hypertrophy. The association is observed in men of all ages, whereas in women it is attenuated by other factors, especially left ventricular hypertrophy. Interracial differences in the stroke risk may exist that need further investigation.
左心房大小与缺血性卒中之间的关联存在争议，有人认为仅在男性中存在这种关联，且由左心室质量介导。几乎所有数据仅来自白人患者。本研究的目的是评估多民族人群中左心房大小与缺血性卒中之间的关联。
对352例年龄大于39岁的首次发生缺血性卒中的患者以及369例年龄、性别和种族匹配的社区对照者进行了一项基于人群的病例对照研究。通过二维经胸超声心动图测量左心房直径，并根据体表面积进行指数化。进行条件逻辑回归分析，以评估在调整其他卒中危险因素后，总体组以及年龄、性别和种族分层中与左心房指数相关的卒中风险。
总体组中，左心房指数与缺血性卒中相关（调整后的比值比为每10 mm/1.7 m²体表面积1.47；95%可信区间为1.03至2.11）。这种关联在男性中存在（调整后的比值比为2.81，95%可信区间为1.42至5.57），而在女性中不存在（调整后的比值比为1.08，95%可信区间为0.70至1.66），在年龄小于60岁的患者中存在（调整后的比值比为3.78，95%可信区间为1.36至10.54），而在年龄大于60岁的患者中不存在（调整后的比值比为1.23，95%可信区间为0.84至1.81）。亚组分析显示，在所有年龄亚组的男性中均存在这种风险。在女性中，左心房指数与卒中之间缺乏关联受左心室肥厚的影响最大。在白人（调整后的比值比为1.81，95%可信区间为0.81至4.09）和西班牙裔（调整后的比值比为1.61，95%可信区间为0.98至2.65）中观察到左心房指数与卒中之间存在关联趋势，但在黑人中不太明显（调整后的比值比为1.25，95%可信区间为0.74至2.14）。
在调整包括左心室肥厚在内的其他卒中危险因素后，左心房扩大与缺血性卒中风险增加相关。在所有年龄段的男性中均观察到这种关联，而在女性中，这种关联被其他因素减弱，尤其是左心室肥厚。卒中风险可能存在种族差异，需要进一步研究。
