Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women

doi:10.4065/76.5.467

Mayo Clinic Proceedings

Volume 76, Issue 5, May 2001, Pages 467-475

https://doi.org/10.4065/76.5.467 Get rights and content

Objective

To evaluate the contribution of left atrial (LA) volume in predicting atrial fibrillation (AF).

Patients and Methods

In this retrospective cohort study, a random sample of 2200 adults was identified from all Olmsted County, Minnesota, residents who had undergone transthoracic echocardiographic assessment between 1990 and 1998 and were 65 years of age or older at the time of examination, were in sinus rhythm, and had no history of AF or other atrial arrhythmias, stroke, pacemaker, congenital heart disease, or valve surgery. The LA volume was measured off-line by using a biplane area-length method. Clinical characteristics and the outcome event of incident AF were determined by retrospective review of medical records. Echocardiographic data were retrieved from the laboratory database. From this cohort, 1655 patients in whom LA size data were available were followed from baseline echocardiogram until development of AF or death. The clinical and echocardiographic associations of AF, especially with respect to the role of LA volume in predicting AF, were determined.

Results

A total of 666 men and 989 women, mean ± SD age of 75.2±7.3 years (range, 65-105 years), were followed for a mean ± SD of 3.97±2.75 years (range, <1.00-10.78 years); 189 (11.4%) developed AF. Cox model 5-year cumulative risks of AF by quartiles of LA volume were 3%, 12%, 15%, and 26%, respectively. With Cox proportional hazards multivariate models, logarithmic LA volume was an independent predictor of AF, incremental to clinical risk factors. After adjusting for age, sex, valvular heart disease, and hypertension, a 30% larger LA volume was associated with a 43% greater risk of AF, incremental to history of congestive heart failure (hazard ratio [HR], 1.887; 95% confidence interval [CI], 1.230-2.895; P=.004), myocardial infarction (HR, 1.751; 95% CI, 1.189-2.577; P=.004), and diabetes (HR, 1.734; 95% CI, 1.066-2.819; P=.03). Left atrial volume remained incremental to combined clinical risk factors and M-mode LA dimension for prediction of AF (P<.001).

Conclusion

This study showed that a larger LA volume was associated with a higher risk of AF in older patients. The predictive value of LA volume was incremental to that of clinical risk profile and conventional M-mode LA dimension.

Section snippets

Study Population and Design

The Mayo Clinic and its 2 affiliated hospitals in Rochester, Minn, together with the Olmsted Medical Center and its affiliated hospital provide more than 95% of medical care delivered to residents of Olmsted County, Minne-sota.¹⁵ Echocardiographic studies at the Olmsted Medical Center during the study period January 1, 1990, through December 31, 1998, were performed and interpreted by Mayo Clinic personnel. Therefore, the population from which the sample was drawn included essentially all

Baseline Characteristics

The study population consisted of 1655 patients (666 men and 989 women) of mean ± SD age 75.2±7.3 years (range, 65-105 years). Compared with men, women were older (mean ± SD age, 76.2±7.6 years vs 73.7±6.7 years; P<.001), shorter (mean ± SD height, 1.59±0.07 m vs 1.75±0.07 m; P<.001), and had smaller BSA (mean ± SD, 1.69±0.19 m² vs 1.96±0.17 m²; P<.001). When normalized to height, LA volume was similar between women and men (mean ± SD, 38.3±15.7 mL/m vs 39.0±16.4 mL/m; P=.60). The mean ± SD LA

DISCUSSION

This study showed a relationship between LA volume and outcome event of AF: LA volume is a significant and independent predictor of incident AF in older patients, incremental to clinical risk factors and M-mode LA dimension. M-mode LA dimension as a predictor of incident AF was demonstrated in both the Framingham Heart Study¹² and the Cardiovascular Health Study.¹³ However, unidimensional M-mode measurement does not provide a sensitive assessment of LA size.¹⁴ The relationship between M-mode LA

CONCLUSION

Left atrial volume appears to be a strong predictor of incident AF, incremental to clinical risk factors and conventional M-mode LA dimension. If confirmed in prospective studies and studies involving other population groups, including younger subjects, LA volume assessment may be a valuable addition to AF risk stratification algorithms.

Acknowledgments

We gratefully acknowledge the contributions of the staff from the Mayo Clinic Echocardiography Research Center, especially Marilyn Leckel, RN, in the data preparation for this project.

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In severe AS, AF is a strong predictor of mortality even in asymptomatic or minimally symptomatic patients. After AVR, AF remains associated with poorer survival than sinus rhythm. In patients in AF, AVR is associated with lower mortality compared with conservative treatment. Further studies are needed to confirm the benefits of AVR in asymptomatic patients in AF with severe AS.
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Citation Excerpt :
The antero-posterior diameter of LA, measured with M-mode or 2D echocardiography, is no longer regarded as the most accurate marker of left atrial size.5,6 Assessment of LA volume is more precise than evaluation of anteroposterior diameter.5,6 Biplane area–length and biplane Simpson's method are the most common methods in clinical practice, in order LA volume to be determined by studying apical 4-, and 2-chamber views.7
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¹: Dr Diamond is now with the Mater Private Hospital, Dublin, Ireland. Dr Marra is now with the Ecocenter, Hospital Vera Cruz, Belo Horizonte

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Original ArticleLeft atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women

Objective

Patients and Methods

Results

Conclusion

Section snippets

Study Population and Design

Baseline Characteristics

DISCUSSION

CONCLUSION

Acknowledgments

Am J Cardiol

Am J Cardiol

Mayo Clin Proc

Chest

J Am Coll Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

Am J Cardiol

Am J Cardiol

Atrial fibrillation as an independent risk factor for stroke: the Framingham Study

Stroke

Stroke severity in atrial fibrillation: the Framingham Study

Stroke

A population-based model of risk factors for ischemic stroke: Rochester, Minnesota

Neurology

Comparison of population-based models of risk factors for TIA and ischemic stroke

Neurology

Impact of atrial fibrillation on the risk of death: the Framingham Heart Study

Circulation

Impact of atrial fibrillation on mortality, stroke, and medical costs

Arch Intern Med

Original Article
Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women