Left atrial size and long-term risk of recurrent stroke after acute ischemic stroke in patients with nonvalvular atrial fibrillation

on behalf of the FSR Investigators

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background--Among patients with ischemic stroke and atrial fibrillation, which ones are at high risk of recurrent stroke is unclear. This study aimed to determine whether left atrial size was associated with long-term risk of stroke recurrence in patients with nonvalvular atrial fibrillation. Methods and Results--In this multicenter prospective cohort study, nonvalvular atrial fibrillation patients hospitalized for acute ischemic stroke were enrolled and followed up after discharge. Indexed-left atrial diameter was obtained by dividing left atrial diameter by body surface area. Cause-specific and subdistribution hazard ratios of recurrent stroke were estimated by Cox proportional hazards and Fine-Gray models, respectively. Risk prediction was evaluated by integrated discrimination improvement and net reclassification improvement. In total, 1611 patients (77.8±10.2 [mean±SD] years, 44.5% female) were included. During follow-up for 2.40±1.63 (mean±SD) years, 251 patients had recurrent stroke and 514 patients died. An increased indexed-left atrial diameter (per 1 cm/m2) was significantly associated with elevated risk of stroke recurrence (hazard ratio 1.60, 95% CI 1.30-1.98). The association was maintained when death was regarded as the competing risk and in 1464 patients who were treated with anticoagulants (hazard ratio 1.59, 95% CI 1.27-2.00). Risk prediction for recurrent stroke was significantly improved by adding indexed-left atrial diameter to the baseline model composed of the factors in the CHADS2 score or those in the CHA2DS2-VASc score. Conclusion--These findings suggest that left atrial enlargement is associated with an increased risk of recurrent stroke in nonvalvular atrial fibrillation patients with ischemic stroke.

Original languageEnglish
Article numbere006402
JournalJournal of the American Heart Association
Volume6
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

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Atrial Fibrillation
Stroke
Recurrence
Body Surface Area
Anticoagulants
Cohort Studies
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Left atrial size and long-term risk of recurrent stroke after acute ischemic stroke in patients with nonvalvular atrial fibrillation. / on behalf of the FSR Investigators.

In: Journal of the American Heart Association, Vol. 6, No. 8, e006402, 01.08.2017.

Research output: Contribution to journalArticle

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title = "Left atrial size and long-term risk of recurrent stroke after acute ischemic stroke in patients with nonvalvular atrial fibrillation",
abstract = "Background--Among patients with ischemic stroke and atrial fibrillation, which ones are at high risk of recurrent stroke is unclear. This study aimed to determine whether left atrial size was associated with long-term risk of stroke recurrence in patients with nonvalvular atrial fibrillation. Methods and Results--In this multicenter prospective cohort study, nonvalvular atrial fibrillation patients hospitalized for acute ischemic stroke were enrolled and followed up after discharge. Indexed-left atrial diameter was obtained by dividing left atrial diameter by body surface area. Cause-specific and subdistribution hazard ratios of recurrent stroke were estimated by Cox proportional hazards and Fine-Gray models, respectively. Risk prediction was evaluated by integrated discrimination improvement and net reclassification improvement. In total, 1611 patients (77.8±10.2 [mean±SD] years, 44.5{\%} female) were included. During follow-up for 2.40±1.63 (mean±SD) years, 251 patients had recurrent stroke and 514 patients died. An increased indexed-left atrial diameter (per 1 cm/m2) was significantly associated with elevated risk of stroke recurrence (hazard ratio 1.60, 95{\%} CI 1.30-1.98). The association was maintained when death was regarded as the competing risk and in 1464 patients who were treated with anticoagulants (hazard ratio 1.59, 95{\%} CI 1.27-2.00). Risk prediction for recurrent stroke was significantly improved by adding indexed-left atrial diameter to the baseline model composed of the factors in the CHADS2 score or those in the CHA2DS2-VASc score. Conclusion--These findings suggest that left atrial enlargement is associated with an increased risk of recurrent stroke in nonvalvular atrial fibrillation patients with ischemic stroke.",
author = "{on behalf of the FSR Investigators} and Toshiyasu Ogata and Ryu Matsuo and Fumi Kiyuna and Jun Hata and Tetsuro Ago and Yoshio Tsuboi and Takanari Kitazono and Masahiro Kamouchi and Takao Ishitsuka and Setsuro Ibayashi and Kenji Kusuda and Kenichiro Fujii and Tetsuhiko Nagao and Yasushi Okada and Masahiro Yasaka and Hiroaki Ooboshi and Katsumi Irie and Tsuyoshi Omae and Kazunori Toyoda and Hiroshi Nakane and Hiroshi Sugimori and Shuji Arakawa and Kenji Fukuda and Jiro Kitayama and Shigeru Fujimoto and Shoji Arihiro and Junya Kuroda and Yoshinobu Wakisaka and Yoshihisa Fukushima",
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T1 - Left atrial size and long-term risk of recurrent stroke after acute ischemic stroke in patients with nonvalvular atrial fibrillation

AU - on behalf of the FSR Investigators

AU - Ogata, Toshiyasu

AU - Matsuo, Ryu

AU - Kiyuna, Fumi

AU - Hata, Jun

AU - Ago, Tetsuro

AU - Tsuboi, Yoshio

AU - Kitazono, Takanari

AU - Kamouchi, Masahiro

AU - Ishitsuka, Takao

AU - Ibayashi, Setsuro

AU - Kusuda, Kenji

AU - Fujii, Kenichiro

AU - Nagao, Tetsuhiko

AU - Okada, Yasushi

AU - Yasaka, Masahiro

AU - Ooboshi, Hiroaki

AU - Irie, Katsumi

AU - Omae, Tsuyoshi

AU - Toyoda, Kazunori

AU - Nakane, Hiroshi

AU - Sugimori, Hiroshi

AU - Arakawa, Shuji

AU - Fukuda, Kenji

AU - Kitayama, Jiro

AU - Fujimoto, Shigeru

AU - Arihiro, Shoji

AU - Kuroda, Junya

AU - Wakisaka, Yoshinobu

AU - Fukushima, Yoshihisa

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background--Among patients with ischemic stroke and atrial fibrillation, which ones are at high risk of recurrent stroke is unclear. This study aimed to determine whether left atrial size was associated with long-term risk of stroke recurrence in patients with nonvalvular atrial fibrillation. Methods and Results--In this multicenter prospective cohort study, nonvalvular atrial fibrillation patients hospitalized for acute ischemic stroke were enrolled and followed up after discharge. Indexed-left atrial diameter was obtained by dividing left atrial diameter by body surface area. Cause-specific and subdistribution hazard ratios of recurrent stroke were estimated by Cox proportional hazards and Fine-Gray models, respectively. Risk prediction was evaluated by integrated discrimination improvement and net reclassification improvement. In total, 1611 patients (77.8±10.2 [mean±SD] years, 44.5% female) were included. During follow-up for 2.40±1.63 (mean±SD) years, 251 patients had recurrent stroke and 514 patients died. An increased indexed-left atrial diameter (per 1 cm/m2) was significantly associated with elevated risk of stroke recurrence (hazard ratio 1.60, 95% CI 1.30-1.98). The association was maintained when death was regarded as the competing risk and in 1464 patients who were treated with anticoagulants (hazard ratio 1.59, 95% CI 1.27-2.00). Risk prediction for recurrent stroke was significantly improved by adding indexed-left atrial diameter to the baseline model composed of the factors in the CHADS2 score or those in the CHA2DS2-VASc score. Conclusion--These findings suggest that left atrial enlargement is associated with an increased risk of recurrent stroke in nonvalvular atrial fibrillation patients with ischemic stroke.

AB - Background--Among patients with ischemic stroke and atrial fibrillation, which ones are at high risk of recurrent stroke is unclear. This study aimed to determine whether left atrial size was associated with long-term risk of stroke recurrence in patients with nonvalvular atrial fibrillation. Methods and Results--In this multicenter prospective cohort study, nonvalvular atrial fibrillation patients hospitalized for acute ischemic stroke were enrolled and followed up after discharge. Indexed-left atrial diameter was obtained by dividing left atrial diameter by body surface area. Cause-specific and subdistribution hazard ratios of recurrent stroke were estimated by Cox proportional hazards and Fine-Gray models, respectively. Risk prediction was evaluated by integrated discrimination improvement and net reclassification improvement. In total, 1611 patients (77.8±10.2 [mean±SD] years, 44.5% female) were included. During follow-up for 2.40±1.63 (mean±SD) years, 251 patients had recurrent stroke and 514 patients died. An increased indexed-left atrial diameter (per 1 cm/m2) was significantly associated with elevated risk of stroke recurrence (hazard ratio 1.60, 95% CI 1.30-1.98). The association was maintained when death was regarded as the competing risk and in 1464 patients who were treated with anticoagulants (hazard ratio 1.59, 95% CI 1.27-2.00). Risk prediction for recurrent stroke was significantly improved by adding indexed-left atrial diameter to the baseline model composed of the factors in the CHADS2 score or those in the CHA2DS2-VASc score. Conclusion--These findings suggest that left atrial enlargement is associated with an increased risk of recurrent stroke in nonvalvular atrial fibrillation patients with ischemic stroke.

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U2 - 10.1161/JAHA.117.006402

DO - 10.1161/JAHA.117.006402

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JO - Journal of the American Heart Association

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