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Left atrial dimension and ischemic stroke in patients with and without atrial fibrillation

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Abstract

The incidence of ischemic stroke (IS) increases in patients with enlarged left atrium (LA) irrespective of whether or not the existence of atrial fibrillation (AF). In such situation, it is unclear whether the impact of LA on incidence of IS still significant in young, non-AF patients with enlarged LA who are primarily unconcerned on anticoagulation therapy. The study population consisted of 18,511 consecutive patients not receiving oral anticoagulants and undergoing echocardiography with measurement of LAD at baseline. The incidence rate of ischemic stroke was calculated in 3 groups according to left atrial dimension (LAD; < 30, 30–45 and ≥ 45 mm) in AF and non-AF patients. Further subgroup analysis was performed in stratification by elderly and young (aged ≥ 65 and < 65 years, respectively). The incidences of IS (per 100 patient-years) were 0.11 and 0.71 in non-AF and AF patients with LAD < 30 mm, respectively, which increased to 0.58 and 1.35 in LAD ≥ 45 mm (adjusted hazard ratios [HRs]; 1.95 [95% confidence intervals, CIs: 0.76–5.01] and 1.22 [95% CIs: 0.27–5.58], interaction P was 0.246). In non-AF patients, the incidences of IS were 0.30 and 0.04 in elderly and young patients with LAD < 30 mm, which increased to 0.67 and 0.48 in LAD ≥ 45 mm (adjusted HRs; 1.34 [95% CIs: 0.43–4.15] and 4.21 [95% CIs: 0.77–23.12], interaction P was 0.158). The incidence of IS significantly increased with increase of LAD in non-AF, especially in non-AF and young patients, although the difference was not independent of other clinical factors. The impact of LAD on IS was numerically larger in non-AF than in AF, and larger in young and non-AF than in elderly counterpart, although a significant interaction was not observed in this small population. Further studies with large population are necessary to judge whether these population with enlarged LA need antithrombotic therapy.

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Acknowledgements

We thank Shiro Ueda and Nobuko Ueda at Medical Edge Company, Ltd., for assembling the database by the Clinical Study Supporting System and Yurika Hashiguchi, Hiroaki Arai, Takashi Osada, and Hiroshi Nakai for data management and system administration.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan

    Naomi Hirota, Shinya Suzuki, Takuto Arita, Naoharu Yagi, Takayuki Otsuka, Mikio Kishi, Hiroaki Semba, Hiroto Kano, Shunsuke Matsuno, Yuko Kato, Tokuhisa Uejima, Yuji Oikawa, Junji Yajima & Takeshi Yamashita

  2. Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan

    Minoru Matsuhama, Mitsuru Iida & Tatsuya Inoue

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  1. Naomi Hirota
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  2. Shinya Suzuki
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Correspondence to Naomi Hirota.

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Conflict of interest

Dr. Suzuki received research funding from Mitsubishi Tanabe Pharm and Daiichi Sankyo. Dr. Yamashita has received research funds and/or lecture fees from Daiichi Sankyo, Bayer Yakuhin, Bristol-Myers Squibb, Pfizer, Nippon Boehringer Ingelheim, Ono Pharmaceutical, and Toa Eiyo.

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Hirota, N., Suzuki, S., Arita, T. et al. Left atrial dimension and ischemic stroke in patients with and without atrial fibrillation. Heart Vessels 36, 1861–1869 (2021). https://doi.org/10.1007/s00380-021-01879-y

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