Kizer Jorge R, Bella Jonathan N, Palmieri Vittorio, Liu Jennifer E, Best Lyle G, Lee Elisa T, Roman Mary J, Devereux Richard B
Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA.
Am Heart J. 2006 Feb;151(2):412-8. doi: 10.1016/j.ahj.2005.04.031.
Echocardiographic left atrial (LA) volume has been documented to be an independent predictor of cardiovascular events. Less is known about the predictive ability of anteroposterior LA diameter, a simpler measure of LA size obtained routinely during echocardiographic evaluation.
We investigated the prognostic value of LA diameter for incident cardiovascular events in 2804 American Indians free of clinical cardiovascular disease, valvular disease, and atrial fibrillation. Echocardiographic variables were obtained using standardized methods, and previously derived sex-specific partition values were used to define left ventricular (LV) hypertrophy indexed to height(2.7) (in meters) and LA enlargement (> 4.2 cm in men, > 3.8 cm in women). Cardiovascular events included nonfatal stroke, coronary heart disease, congestive heart failure, and fatal cardiovascular disease based on validated definitions.
During a median follow-up of 7 years, 368 events occurred. LA diameter, both as a continuous and as a categorical variable, was significantly associated with incident cardiovascular events in unadjusted analyses. In multivariable analyses that adjusted for age, sex, body mass index, hypertension, diabetes, total cholesterol-high-density lipoprotein cholesterol, smoking, renal insufficiency, LV hypertrophy, abnormal LV systolic and diastolic function, mitral annular calcification, fibrinogen, and C-reactive protein, both LA diameter (risk ratio 1.04/mm, 95% CI 1.02-1.07, P < .002) and LA enlargement (risk ratio 1.57, 95% CI 1.17-2.10, P = .002) remained independent predictors of first cardiovascular events.
In this population-based cohort, LA diameter independently predicted incident cardiovascular events after adjustment for established clinical, echocardiographic, and inflammatory risk factors. This simple measure of LA dilatation can identify individuals at heightened risk who may warrant more aggressive risk factor modification.
超声心动图测量的左心房（LA）容积已被证明是心血管事件的独立预测指标。对于前后径LA直径的预测能力了解较少，LA直径是在超声心动图评估过程中常规获得的一种更简单的LA大小测量指标。
我们调查了2804名无临床心血管疾病、瓣膜疾病和心房颤动的美国印第安人中LA直径对心血管事件发生的预后价值。使用标准化方法获取超声心动图变量，并使用先前得出的性别特异性划分值来定义以身高（2.7）（米）为指数的左心室（LV）肥厚和LA扩大（男性>4.2 cm，女性>3.8 cm）。心血管事件包括基于有效定义的非致命性中风、冠心病、充血性心力衰竭和致命性心血管疾病。
在中位随访7年期间，发生了368起事件。在未调整分析中，LA直径作为连续变量和分类变量均与心血管事件发生显著相关。在对年龄、性别、体重指数、高血压、糖尿病、总胆固醇-高密度脂蛋白胆固醇、吸烟、肾功能不全、LV肥厚、LV收缩和舒张功能异常、二尖瓣环钙化、纤维蛋白原和C反应蛋白进行调整的多变量分析中，LA直径（风险比1.04/mm，95%CI 1.02-1.07，P<.002）和LA扩大（风险比1.57，95%CI 1.17-2.10，P=.002）仍然是首次心血管事件的独立预测指标。
在这个基于人群的队列中，在对既定的临床、超声心动图和炎症风险因素进行调整后，LA直径独立预测心血管事件发生。这种简单的LA扩张测量方法可以识别出风险增加的个体，这些个体可能需要更积极地进行风险因素调整。
