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Association with left atrial volume index and long-term prognosis in patients without systolic dysfunction nor atrial fibrillation: an observational study

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Abstract

The prognostic impact of left atrial size in patients without systolic dysfunction nor atrial fibrillation (AF) has not been fully elucidated in Japan. We retrospectively analyzed data obtained from 4444 consecutive patients who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in our hospital. Those who presented with a history of myocardial infarctions, severe and moderate valvular diseases, low ejection fraction (< 50%), and documented AF, and without data on LA volume index (LAVI) or tissue Doppler early diastolic mitral annular velocity were excluded. We defined high LAVI as a value > 34 ml/m2. The primary outcome measure was a composite of all-cause death and major adverse cardiac events. A total of 2792 patients were categorized into two groups: 2627 with normal LAVI (94.1%), 165 with high LAVI (5.9%). The median age of patients in the normal and high LAVI groups were 67, and 77 years, respectively (p < 0.001). Prevalence of diabetes mellitus, hypertension, and chronic kidney disease, and left ventricular mass index was higher in the high-LAVI group than normal-LAVI group. After adjusting for confounders, the excess 3-year risk of primary outcome of high-LAVI related to normal-LAVI was significant (hazard ratio 1.44; 95% confidence interval 1.03–1.97, p = 0.032). High-LAVI should be considered a marker of a worse long-term follow-up in patients without systolic dysfunction nor AF.

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Authors and Affiliations

  1. Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan

    Yuta Seko, Yusuke Morita, Yuhei Yamaji, Yoshizumi Haruna, Eisaku Nakane, Tetsuya Haruna & Moriaki Inoko

  2. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Takao Kato

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  1. Yuta Seko
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  2. Takao Kato
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Contributions

YS and TK: conceived the design, performed statistical analysis, and wrote manuscript. YM, YY, YH, TI, SM, EN, HH, TH and MI: collected the data and made critical revision.

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Correspondence to Takao Kato.

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380_2019_1469_MOESM1_ESM.tif

Supplementary Fig 1. Propensity score distribution in the high and normal LAVI groups. Mirrored histogram of distribution of propensity score for patients in the high LAVI group and in the normal LAVI group (TIFF 1139 kb)

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Seko, Y., Kato, T., Morita, Y. et al. Association with left atrial volume index and long-term prognosis in patients without systolic dysfunction nor atrial fibrillation: an observational study. Heart Vessels 35, 223–231 (2020). https://doi.org/10.1007/s00380-019-01469-z

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