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Relation of Left Atrial Enlargement to Subsequent Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients With Low to Borderline Embolic Risk

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Abstract
The current thromboembolic risk stratification of non-valvular atrial fibrillation (NVAF) does not include parameters from transthoracic echocardiography (TTE). We hypothesized that left atrial enlargement (LAE) on TTE could discriminate who require anticoagulation therapy among NVAF patients with low/borderline clinical embolic risk. This single-center cohort study included 6,602 patients with NVAF (median age, 56 years, 70.0% male) with a low to borderline clinical embolic risk (CHA(2)DS(2)-VASc score: 0 to 1 in males, 1 to 2 in females). LAE was classified as mild (>= 41 mm in males; >= 39 mm in females) or moderate-severe (>= 47 mm in males; >= 43 mm in females). The main study outcome was thromboembolic event (ischemic stroke and systemic embolism). Mild and moderate-severe LAE was diagnosed in 26.1% and 32.9% of the cohort, respectively. The patients with moderate-severe LAE showed a higher prevalence of baseline comorbidities and valvular heart disease and had a higher incidence of thromboembolic events than patients with mild or no LAE at 2 years of follow-up (2.5% vs 1.3% vs 1.1%, respectively, p < 0.001). After multivariable adjustment, patients with moderate-severe LAE were at a higher risk of thromboembolic event (hazard ratio, 2.54; 95% CI, 1.65 to 3.90; p < 0.001) compared to those with no LAE. This result persisted in a subgroup analysis of anticoagulant-nayve patients. The rate of thromboembolic events in patients with low clinical embolic risk and moderate-severe LAE was not different to those with high clinical embolic risk without LAE. In conclusion, Moderate-severe LAE on TTE was a significant predictor of thromboembolic events in NVAF patients at low/borderline clinical embolic risk. (C) 2020 Elsevier Inc. All rights reserved.
Author(s)
김민수김준남기병도웅정조민수최기준
Issued Date
2021
Type
Article
Keyword
Abridged Index MedicusAdultAgedAnticoagulants - therapeutic useAtrial Fibrillation - complicationsAtrial Fibrillation - diagnostic imagingAtrial Fibrillation - drug therapyEchocardiographyFemaleHeart Atria - diagnostic imagingHeart Atria - pathologyHumansIncidence Ischemic Stroke - epidemiology Ischemic Stroke - etiology Ischemic Stroke - prevention &amp; control Male Middle Aged Organ Size Proportional Hazards Models Republic of Korea - epidemiology Retrospective Studies Risk Assessment Thromboembolism - epidemiology Thromboembolism - etiology Thromboembolism - prevention &amp; control
DOI
10.1016/j.amjcard.2020.12.034
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7012
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2473416897&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Relation%20of%20Left%20Atrial%20Enlargement%20to%20Subsequent%20Thromboembolic%20Events%20in%20Nonvalvular%20Atrial%20Fibrillation%20Patients%20With%20Low%20to%20Borderline%20Embolic%20Risk&amp;offset=0&amp;pcAvailability=true
Publisher
AMERICAN JOURNAL OF CARDIOLOGY
Location
미국
Language
영어
ISSN
0002-9149
Citation Volume
143
Citation Number
1
Citation Start Page
67
Citation End Page
73
Appears in Collections:
Medicine > Medicine
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