Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain.
CMAJ. 2011 Jul 12;183(10):E657-64. doi: 10.1503/cmaj.091688. Epub 2011 May 24.
Limited data are available on the relation between left atrial size and outcome among patients referred for clinically indicated echocardiograms. Our aim was to assess the association of left atrial size with all-cause mortality and ischemic stroke in a large cohort of patients referred for echocardiography.
Left atrial diameter was measured in 52 639 patients aged 18 years or older (mean age 61.8 [standard deviation (SD) 16.3] years; 52.9% men) who underwent a first transthoracic echocardiogram for clinical reasons at our institution between April 1990 and March 2008. The outcomes were all-cause mortality and nonfatal ischemic stroke.
Based on the criteria of the American Society of Echocardiography, 50.4% of the patients had no left atrial enlargement, whereas 24.5% had mild, 13.3% had moderate and 11.7% had severe left atrial enlargement. Over a mean follow-up period of 5.5 (SD 4.1) years, 12 527 patients died, and 2314 patients had a nonfatal ischemic stroke. Cumulative 10-year survival was 73.7% among patients with normal left atrial size, 62.5% among those with mild enlargement, 54.8% among those with moderate enlargement and 45% among those with severe enlargement (p < 0.001). After adjustment in multivariable Cox proportional hazard analysis, left atrial diameter remained a predictor of all-cause mortality in both sexes (hazard ratio [HR] per 1-cm increment in left atrial size 1.17, 95% confidence interval [CI] 1.12-1.22, p < 0.001 in women, and HR 1.09, 95% CI 1.05-1.13, p < 0.001 in men) and of ischemic stroke in women (HR 1.25, 95% CI 1.14-1.37, p < 0.001).
Left atrial diameter has a graded and independent association with all-cause mortality in both sexes and with ischemic stroke in women.
在因临床指征而行超声心动图检查的患者中，左心房大小与预后的关系相关数据有限。我们的目的是评估左心房大小与大量因临床原因行超声心动图检查的患者的全因死亡率和缺血性卒中之间的相关性。
我们对 1990 年 4 月至 2008 年 3 月在我们机构因临床原因首次行经胸超声心动图检查的 52639 名年龄在 18 岁及以上（平均年龄 61.8[标准差 16.3]岁；52.9%为男性）的患者的左心房直径进行了测量。结局为全因死亡率和非致死性缺血性卒中。
根据美国超声心动图学会的标准，50.4%的患者无左心房扩大，24.5%的患者有轻度扩大，13.3%的患者有中度扩大，11.7%的患者有重度扩大。在平均 5.5（标准差 4.1）年的随访期间，12527 名患者死亡，2314 名患者发生非致死性缺血性卒中。左心房大小正常的患者 10 年累积生存率为 73.7%，轻度扩大的患者为 62.5%，中度扩大的患者为 54.8%，重度扩大的患者为 45%（p<0.001）。在多变量 Cox 比例风险分析中调整后，左心房直径仍然是两性全因死亡率的预测因素（每增加 1cm 左心房大小，风险比[HR]为 1.17，95%置信区间[CI]为 1.12-1.22，p<0.001；女性）和女性缺血性卒中（HR 1.25，95%CI 1.14-1.37，p<0.001）。
左心房直径与两性的全因死亡率以及女性的缺血性卒中呈分级和独立相关。
