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Published on: February 20, 2017
Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography
Abhishek Khemka1, David A Sutter2, Mazin N Habhab3
1Department of Medicine, Division of Cardiology, Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN 46202, United States. akhemka@iu.edu.
Insights
Left atrial enlargement is uncommon in African American patients with hypertension. However, a lower threshold for left atrial diameter (≥ 2.05 cm/m²) independently predicts mortality in this population.
Area of Science:
- Cardiology
- Echocardiography
- Public Health
Background:
- Left atrial (LA) enlargement is a known risk marker in the general population undergoing stress echocardiography.
- African American (AA) patients with hypertension exhibit less atrial remodeling compared to White patients.
- The prognostic significance of LA enlargement in hypertensive AA individuals undergoing stress echocardiography remains uncertain.
Purpose of the Study:
- To determine the prognostic value of left atrial size in hypertensive African American patients undergoing stress echocardiography.
- To assess the association between left atrial diameter and all-cause mortality in this specific demographic.
Main Methods:
- Retrospective analysis of 583 consecutive hypertensive AA patients who underwent stress echocardiography.
- Collection of clinical characteristics, cardiovascular risk factors, and echocardiographic data.
- Follow-up for all-cause mortality, with optimal cutoff for LA diameter determined by ROC analysis and Cox regression for outcome association.
Main Results:
- Left atrial dilatation (LA anteroposterior ≥ 2.4 cm/m²) was observed in 9% of patients.
- An optimal cutoff of LA diameter ≥ 2.05 cm/m² was associated with increased mortality (HR 1.73).
- Independent predictors of mortality included age, tobacco use, left ventricular hypertrophy, Dobutamine stress, heart failure history, and abnormal stress echocardiogram.
Conclusions:
- Left atrial enlargement is infrequent in hypertensive AA patients using traditional reference values.
- A lower threshold for LA diameter (≥ 2.05 cm/m²) is independently associated with mortality in this population, suggesting a need for revised prognostic criteria.
Background:
Left atrial (LA) enlargement is a marker of increased risk in the general population undergoing stress echocardiography. African American (AA) patients with hypertension are known to have less atrial remodeling than whites with hypertension. The prognostic impact of LA enlargement in AA with hypertension undergoing stress echocardiography is uncertain.
Aim:
To investigate the prognostic value of LA size in hypertensive AA patients undergoing stress echocardiography.
Methods:
This retrospective outcomes study enrolled 583 consecutive hypertensive AA patients who underwent stress echocardiography over a 2.5-year period. Clinical characteristics including cardiovascular risk factors, stress and echocardiographic data were collected from the electronic health record of a large community hospital. Treadmill exercise and Dobutamine protocols were conducted based on standard practices. Patients were followed for all-cause mortality. The optimal cutoff value of antero-posterior LA diameter for mortality was assessed by receiver operating characteristic analysis. Cox regression was used to determine variables associated with outcome.
Results:
The mean age was 57 ± 12 years. LA dilatation was present in 9% (54) of patients (LA anteroposterior ≥ 2.4 cm/m2). There were 85 deaths (15%) during 4.5 ± 1.7 years of follow-up. LA diameter indexed for body surface area had an area under the curve of 0.72 ± 0.03 (optimal cut-point of 2.05 cm/m2). Variables independently associated with mortality included age [P = 0.004, hazard ratio (HR) 1.34 (1.10-1.64)], tobacco use [P = 0.001, HR 2.59 (1.51-4.44)], left ventricular hypertrophy [P = 0.001 , HR 2.14 (1.35-3.39)], Dobutamine stress [P = 0.003, HR 2.12 (1.29-3.47)], heart failure history [P = 0.031, HR 1.76 (1.05-2.94)], LA diameter ≥ 2.05 cm/m2 [P = 0.027, HR 1.73 (1.06-2.82)], and an abnormal stress echocardiogram [P = 0.033, HR 1.67 (1.04-2.68)]. LA diameter as a continuous variable was also independently associated with mortality but LA size ≥ 2.40 cm/m2 was not.
Conclusion:
LA enlargement is infrequent in hypertensive AA patients when traditional reference values are used. LA enlargement is independently associated with mortality when a lower than "normal" threshold (≥ 2.05 cm/m2) is used.
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