Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
J Am Heart Assoc. 2017 Aug 15;6(8):e006402. doi: 10.1161/JAHA.117.006402.
Among patients with ischemic stroke and atrial fibrillation, which ones are at high risk of recurrent stroke is unclear. This study aimed to determine whether left atrial size was associated with long-term risk of stroke recurrence in patients with nonvalvular atrial fibrillation.
In this multicenter prospective cohort study, nonvalvular atrial fibrillation patients hospitalized for acute ischemic stroke were enrolled and followed up after discharge. Indexed-left atrial diameter was obtained by dividing left atrial diameter by body surface area. Cause-specific and subdistribution hazard ratios of recurrent stroke were estimated by Cox proportional hazards and Fine-Gray models, respectively. Risk prediction was evaluated by integrated discrimination improvement and net reclassification improvement. In total, 1611 patients (77.8±10.2 [mean±SD] years, 44.5% female) were included. During follow-up for 2.40±1.63 (mean±SD) years, 251 patients had recurrent stroke and 514 patients died. An increased indexed-left atrial diameter (per 1 cm/m) was significantly associated with elevated risk of stroke recurrence (hazard ratio 1.60, 95% CI 1.30-1.98). The association was maintained when death was regarded as the competing risk and in 1464 patients who were treated with anticoagulants (hazard ratio 1.59, 95% CI 1.27-2.00). Risk prediction for recurrent stroke was significantly improved by adding indexed-left atrial diameter to the baseline model composed of the factors in the CHADS score or those in the CHADS-VASc score.
These findings suggest that left atrial enlargement is associated with an increased risk of recurrent stroke in nonvalvular atrial fibrillation patients with ischemic stroke.
在患有缺血性卒中和心房颤动的患者中，哪些患者发生复发性卒中的风险较高尚不清楚。本研究旨在确定左心房大小与非瓣膜性心房颤动患者的长期卒中复发风险是否相关。
在这项多中心前瞻性队列研究中，招募了因急性缺血性卒中住院的非瓣膜性心房颤动患者，并在出院后进行随访。通过将左心房直径除以体表面积来获得左心房指数直径。通过 Cox 比例风险和 Fine-Gray 模型分别估计复发性卒中的病因特异性和亚分布风险比。通过综合判别改善和净重新分类改善来评估风险预测。共纳入 1611 例患者（77.8±10.2[均数±标准差]岁，44.5%为女性）。在 2.40±1.63（均数±标准差）年的随访期间，251 例患者发生复发性卒中，514 例患者死亡。左心房指数直径（每 1cm/m）增加与卒中复发风险升高显著相关（风险比 1.60，95%CI 1.30-1.98）。当将死亡视为竞争风险时，以及在 1464 例接受抗凝治疗的患者中，这种相关性仍然存在（风险比 1.59，95%CI 1.27-2.00）。通过将左心房指数直径添加到由 CHADS 评分或 CHADS-VASc 评分中的因素组成的基线模型中，可显著改善复发性卒中的风险预测。
这些发现表明，左心房扩大与缺血性卒中伴非瓣膜性心房颤动患者的复发性卒中风险增加相关。
