Department of Cardiology, Odense University Hospital, Odense, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Cardiovascular Centre of Excellence (CAVAC), Denmark; Odense University Hospital, Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark.
Int J Cardiol. 2021 Apr 1;328:220-226. doi: 10.1016/j.ijcard.2020.12.029. Epub 2020 Dec 30.
Enlargement of left atrium (LA) is a valuable marker of cardiovascular events, and LA size is readily available while performing non-contrast cardiac computed tomography (NCCT) for preventive purposes. We aimed to evaluate the predictive value of a single LA area from NCCT in a population-based cohort.
Mainly men aged 60-75 years from DANCAVAS were included. Traditional risk factors were recorded, and an NCCT scan performed at baseline. Coronary artery calcifications (CAC) score and the largest LA area were measured. LA was indexed to body surface area and categorised into four groups. Data on incident atrial fibrillation (AF), thromboembolic events, heart failure (HF) and death were obtained from Danish national registries.
In total, 14,557 individuals were eligible, excluding those without LA measurement (N = 232) and with heart valve replacement (N = 197). Known AF or HF were respectively excluded from follow-up. Median follow-up time was 2.1 to 3.4 years. In total, 304 developed AF, 149 had thromboembolism, 129 developed HF and 482 died. In adjusted analysis, LA enlargement was associated with AF (HR (95% CI): large 1.99 (1.46-2.71) and very large LA 3.77 (2.31-6.14)) and HF (large 2.40 (1.50-3.85) and very large LA 6.54 (4.07-10.51)). A very large LA significantly increased mortality (HR: 2.01 (1.44-2.82)), and was associated with a two-fold increased risk of thromboembolism; however, not significantly in adjusted analysis (p = 0.09).
We demonstrated that determination of LA area from NCCT was an important predictor of AF, HF and death. This knowledge could inform current risk assessment beyond CAC score.
左心房（LA）扩大是心血管事件的一个有价值的标志物，并且在进行非对比心脏计算机断层扫描（NCCT）进行预防时，很容易获得 LA 大小。我们旨在评估人群中来自 NCCT 的单个 LA 区域的预测价值。
主要纳入年龄在 60-75 岁的 DANCAVAS 男性。记录传统危险因素，并在基线时进行 NCCT 扫描。测量冠状动脉钙化（CAC）评分和最大 LA 面积。将 LA 指数化到体表面积并分为四组。从丹麦国家登记处获得心房颤动（AF）、血栓栓塞事件、心力衰竭（HF）和死亡的发病数据。
共有 14557 人符合条件，排除了无 LA 测量（N=232）和心脏瓣膜置换术（N=197）的患者。已知的 AF 或 HF 分别从随访中排除。中位随访时间为 2.1 至 3.4 年。共有 304 人发生 AF，149 人发生血栓栓塞，129 人发生 HF，482 人死亡。在调整分析中，LA 扩大与 AF（HR（95%CI）：大 LA 1.99（1.46-2.71）和非常大 LA 3.77（2.31-6.14））和 HF（大 LA 2.40（1.50-3.85）和非常大 LA 6.54（4.07-10.51））相关。非常大的 LA 显著增加了死亡率（HR：2.01（1.44-2.82）），并与血栓栓塞风险增加两倍相关；然而，在调整分析中没有显著相关性（p=0.09）。
我们证明了从 NCCT 确定 LA 面积是 AF、HF 和死亡的重要预测因子。这一知识可以为 CAC 评分以外的当前风险评估提供信息。
