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(Stroke. 2008;39:2701.)
© 2008 American Heart Association, Inc.

Original Contributions

The Predictive Value of Left Atrial Size for Incident Ischemic Stroke and All-Cause Mortality in African Americans

The Atherosclerosis Risk in Communities (ARIC) Study

Harsha S. Nagarajarao, MD; Alan D. Penman, MBChB, PhD, MSc, MPH; Herman A. Taylor, MD, MPH; Thomas H. Mosley, PhD; Kenneth Butler, PhD; Thomas N. Skelton, MD; Tandaw E. Samdarshi, MD, MPH; Giorgio Aru, MD Ervin R. Fox, MD, MPH

From the University of Mississippi Medical Center, Jackson.

Correspondence to Ervin Fox, MD, MPH, Co-Principal Investigator, Atherosclerosis Risk In Communities (ARIC) Study, Associate Professor of Medicine University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216. E-mail efox{at}medicine.umsmed.edu

Background and Purpose— The association between left atrial (LA) size, ischemic stroke, and death has not been well established in African Americans despite their disproportionately higher rates of stroke and cardiovascular mortality compared to non-Hispanic whites.

Methods— For the analysis, participants in the Jackson cohort of the Atherosclerosis Risk in Communities Study were followed from the date of the echocardiogram in cycle three to the date of the first ischemic stroke event (or death) or to December 31, 2004 if no ischemic stroke event (or death) was detected.

Results— There were 1886 participants in the study population (mean age 58.9 years, 65% women). Participants in the top quintile of LA diameter indexed to height (LA diameter/height; 2.57 to 3.55 cm/m) were more likely women, hypertensive, diabetic, and obese compared to those not in the top quintile. Over a median follow-up of 9.8 years for ischemic stroke and 9.9 years for all-cause mortality, there were 106 strokes and 242 deaths. In a multivariable model adjusting for traditional clinical risk factors, the top quintile of LA diameter/height was significantly related to ischemic stroke (HR 1.7; 95% CI: 1.1, 2.7) and all-cause mortality (HR 2.0; 95% CI: 1.5, 2.7). After further adjustment for left ventricular (LV) hypertrophy and low LV ejection fraction, the top quintile remained significantly related to all-cause mortality (HR 1.8; 95% CI: 1.3, 2.5).

Conclusions— In this population-based cohort of African Americans, LA size was a predictor of all-cause mortality after adjusting for traditional cardiovascular risk factors, LV hypertrophy, and low LV ejection fraction.

Key Words: echocardiography • hypertension • risk factors