Pierdomenico Sante D, Pierdomenico Anna M, Di Carlo Silvio, Di Tommaso Roberta, Cuccurullo Franco
Dipartimento di Medicina e Scienze dell'Invecchiamento, Università Gabriele d'Annunzio, Chieti, Italy; Centro di Ricerca Clinica, Fondazione Università Gabriele d'Annunzio, Chieti, Italy.
Centro di Ricerca Clinica, Fondazione Università Gabriele d'Annunzio, Chieti, Italy.
Am J Hypertens. 2014 Sep;27(9):1179-84. doi: 10.1093/ajh/hpu042. Epub 2014 Mar 28.
The independent prognostic significance of left atrial enlargement is not yet completely clear. We investigated the association between left atrial enlargement and risk of ischemic stroke in elderly treated hypertensive patients.
The occurrence of ischemic stroke was evaluated in 1,191 elderly treated hypertensive patients (age range = 60-90 years). Left atrium diameter (cm) was indexed by body surface area (m(2)) and subjects were divided into those with normal or enlarged (≥2.4cm/m(2)) left atrium.
During the follow-up (9.1±4.9 years; range = 0.4-20 years), 139 ischemic strokes occurred. The event rate per 100 patient-years was 1.28. There were 86 strokes in patients with normal (= 928) left atrium and 53 strokes in patients with enlarged (= 263) left atrium, respectively. Stroke-free survival curves were significantly different between the groups (P < 0.01). After adjustment for various covariables, including clinical variables, left ventricular hypertrophy, and ambulatory blood pressure parameters, Cox regression analysis showed that left atrial enlargement was significantly associated with increased risk of ischemic stroke (hazard ratio = 1.54; 95% confidence interval = 1.05-2.27; P = 0.03).
In elderly treated hypertensive patients, left atrial enlargement is an independent predictor of ischemic stroke.
左心房扩大的独立预后意义尚未完全明确。我们研究了老年高血压患者左心房扩大与缺血性卒中风险之间的关联。
对1191例老年高血压患者（年龄范围60 - 90岁）的缺血性卒中发生情况进行评估。左心房直径（cm）通过体表面积（m²）进行指数化，受试者被分为左心房正常或扩大（≥2.4cm/m²）的两组。
在随访期间（9.1±4.9年；范围0.4 - 20年），发生了139例缺血性卒中。每100患者年的事件发生率为1.28。左心房正常（= 928例）的患者中有86例卒中，左心房扩大（= 263例）的患者中有53例卒中。两组间无卒中生存曲线有显著差异（P < 0.01）。在对包括临床变量、左心室肥厚和动态血压参数等各种协变量进行调整后，Cox回归分析显示左心房扩大与缺血性卒中风险增加显著相关（风险比 = 1.54；95%置信区间 = 1.05 - 2.27；P = 0.03）。
在老年高血压患者中，左心房扩大是缺血性卒中的独立预测因素。
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