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Eur Heart J Cardiovasc Imaging. 2014 Aug;15(8):893-9. doi: 10.1093/ehjci/jeu018. Epub 2014 Feb 16.

Left atrial dimension and traditional cardiovascular risk factors predict 20-year clinical cardiovascular events in young healthy adults: the CARDIA study.

Author information

1
Department of Cardiology/Cardiovascular Imaging, Johns Hopkins University, 600 N. Wolfe Street/Blalock 524, Baltimore, MD 21287-0409, USA Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil.
2
Northwestern University, Chicago, IL, USA.
3
University of Alabama at Birmingham, Birmingham, AL, USA.
4
Kaiser Permanente, Oakland, CA, USA.
5
Department of Cardiology/Cardiovascular Imaging, Johns Hopkins University, 600 N. Wolfe Street/Blalock 524, Baltimore, MD 21287-0409, USA.
6
University of Minnesota, Minneapolis, MN, USA.
7
Escola Bahiana de Medicina, Salvador, BA, Brazil.
8
Nemours Cardiac Center, Wilmington, DE, USA.
9
Department of Cardiology/Cardiovascular Imaging, Johns Hopkins University, 600 N. Wolfe Street/Blalock 524, Baltimore, MD 21287-0409, USA jlima@jhmi.edu.

Abstract

AIMS:

We investigated whether the addition of left atrial (LA) size determined by echocardiography improves cardiovascular risk prediction in young adults over and above the clinically established Framingham 10-year global CV risk score (FRS).

METHODS AND RESULTS:

We included white and black CARDIA participants who had echocardiograms in Year-5 examination (1990-91). The combined endpoint after 20 years was incident fatal or non-fatal cardiovascular disease: myocardial infarction, heart failure, cerebrovascular disease, peripheral artery disease, and atrial fibrillation/flutter. Echocardiography-derived M-mode LA diameter (LAD; n = 4082; 149 events) and 2D four-chamber LA area (LAA; n = 2412; 77 events) were then indexed by height or body surface area (BSA). We used Cox regression, areas under the receiver operating characteristic curves (AUC), and net reclassification improvement (NRI) to assess the prediction power of LA size when added to calculated FRS or FRS covariates. The LAD and LAA cohorts had similar characteristics; mean LAD/height was 2.1 ± 0.3 mm/m and LAA/height 9.3 ± 2.0 mm(2)/m. After indexing by height and adjusting for FRS covariates, hazard ratios were 1.31 (95% CI 1.12, 1.60) and 1.43 (95% CI 1.13, 1.80) for LAD and LAA, respectively; AUC was 0.77 for LAD and 0.78 for LAA. When LAD and LAA were indexed to BSA, the results were similar but slightly inferior. Both LAD and LAA showed modest reclassification ability, with non-significant NRIs.

CONCLUSION:

LA size measurements independently predict clinical outcomes. However, it only improves discrimination over clinical parameters modestly without altering risk classification. Indexing LA size by height is at least as robust as by BSA. Further research is needed to assess subgroups of young adults who may benefit from LA size information in risk stratification.

KEYWORDS:

Cardiovascular events; Echocardiography; Left atrial size; Young adults

PMID:
24534011
PMCID:
PMC4215562
DOI:
10.1093/ehjci/jeu018
[Indexed for MEDLINE]
Free PMC Article
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