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Published on: February 26, 2013
Left atrial size and risk of stroke in patients in sinus rhythm. A systematic review
Thure Filskov Overvad, Peter Brønnum Nielsen, Torben Bjerregaard Larsen
1Peter Søgaard, MD, DMSc, Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark, Tel.: +45 97 66 44 39,
Insights
Left atrial enlargement in patients with normal heart rhythm significantly increases stroke risk. Further research is needed to identify individuals who may benefit from preventative antithrombotic therapy.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- The association between left atrial enlargement and stroke risk in patients with normal sinus rhythm is not well-established.
- There is a potential unmet need for thromboprophylaxis in this patient group.
Purpose of the Study:
- To systematically review existing evidence on left atrial size and stroke risk in patients maintaining sinus rhythm.
- To assess whether left atrial enlargement is a significant predictor of stroke in this population.
Main Methods:
- A systematic review of nine cohort studies was conducted.
- Data from 67,875 participants and 3,093 stroke outcomes were analyzed.
- Stroke rates were compared between patients with and without left atrial enlargement.
Main Results:
- All included studies indicated a higher stroke risk associated with larger or enlarged left atria compared to normal-sized left atria.
- Stroke rates per 100 person-years ranged from 0.59 to 2.06 in patients with left atrial enlargement and sinus rhythm.
- Two studies suggested that the association might be modified by sex, with positive associations observed only in women.
Conclusions:
- Left atrial enlargement appears to be an important stroke predictor across diverse patient populations in sinus rhythm.
- The increased risk is likely multifactorial, not solely attributable to direct thromboembolic effects of left atrial enlargement.
- Formal stroke risk stratification in patients with left atrial enlargement may identify candidates for preventive antithrombotic therapy.
Abstract:
Little is known about the risk of stroke associated with left atrial enlargement in patients in sinus rhythm, and whether such patients may have an unmet need for thromboprophylaxis. In this systematic review we summarise the existing evidence concerning left atrial size and risk of stroke in patients in sinus rhythm. Nine cohort studies were identified, analysing a total of 67,875 participants and 3,093 stroke outcomes. Rates of stroke per 100 person-years in patients with left atrial enlargement and in sinus rhythm ranged from 0.59 in a population-based cohort to 2.06 in patients referred for echocardiography. All studies reported a higher risk of stroke with larger/enlarged left atrium compared to smaller/normal sized left atrium. Two studies found indications of modification by sex, with only positive associations observed in women. Left atrial enlargement may represent an important predictor of stroke across a variety of patient populations in sinus rhythm. The underlying aetiology explaining this observed higher risk is likely to be multifactorial and not confined to a potential direct effect of left atrial enlargement on thromboembolic risk. Formal stroke risk stratification among patients with left atrial enlargement may further help identify patients who stand to gain from preventive antithrombotic therapy.
