Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults

The Strong Heart Study (SHS)

Jorge Kizer, Jonathan N. Bella, Vittorio Palmieri, Jennifer E. Liu, Lyle G. Best, Elisa T. Lee, Mary J. Roman, Richard B. Devereux

Research output: Contribution to journalArticle

255 Citations (Scopus)

Abstract

Background: Echocardiographic left atrial (LA) volume has been documented to be an independent predictor of cardiovascular events. Less is known about the predictive ability of anteroposterior LA diameter, a simpler measure of LA size obtained routinely during echocardiographic evaluation. Methods: We investigated the prognostic value of LA diameter for incident cardiovascular events in 2804 American Indians free of clinical cardiovascular disease, valvular disease, and atrial fibrillation. Echocardiographic variables were obtained using standardized methods, and previously derived sex-specific partition values were used to define left ventricular (LV) hypertrophy indexed to height2.7 (in meters) and LA enlargement (>4.2 cm in men, >3.8 cm in women). Cardiovascular events included nonfatal stroke, coronary heart disease, congestive heart failure, and fatal cardiovascular disease based on validated definitions. Results: During a median follow-up of 7 years, 368 events occurred. LA diameter, both as a continuous and as a categorical variable, was significantly associated with incident cardiovascular events in unadjusted analyses. In multivariable analyses that adjusted for age, sex, body mass index, hypertension, diabetes, total cholesterol-high-density lipoprotein cholesterol, smoking, renal insufficiency, LV hypertrophy, abnormal LV systolic and diastolic function, mitral annular calcification, fibrinogen, and C-reactive protein, both LA diameter (risk ratio 1.04/mm, 95% CI 1.02-1.07, P < .002) and LA enlargement (risk ratio 1.57, 95% CI 1.17-2.10, P = .002) remained independent predictors of first cardiovascular events. Conclusions: In this population-based cohort, LA diameter independently predicted incident cardiovascular events after adjustment for established clinical, echocardiographic, and inflammatory risk factors. This simple measure of LA dilatation can identify individuals at heightened risk who may warrant more aggressive risk factor modification.

Original languageEnglish (US)
Pages (from-to)412-418
Number of pages7
JournalAmerican Heart Journal
Volume151
Issue number2
DOIs
StatePublished - Feb 2006
Externally publishedYes

Fingerprint

Left Ventricular Hypertrophy
Cardiovascular Diseases
Odds Ratio
Aptitude
North American Indians
C-Reactive Protein
Fibrinogen
Atrial Fibrillation
HDL Cholesterol
Renal Insufficiency
Coronary Disease
Dilatation
Body Mass Index
Heart Failure
Smoking
Stroke
Cholesterol
Hypertension
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults : The Strong Heart Study (SHS). / Kizer, Jorge; Bella, Jonathan N.; Palmieri, Vittorio; Liu, Jennifer E.; Best, Lyle G.; Lee, Elisa T.; Roman, Mary J.; Devereux, Richard B.

In: American Heart Journal, Vol. 151, No. 2, 02.2006, p. 412-418.

Research output: Contribution to journalArticle

Kizer, Jorge ; Bella, Jonathan N. ; Palmieri, Vittorio ; Liu, Jennifer E. ; Best, Lyle G. ; Lee, Elisa T. ; Roman, Mary J. ; Devereux, Richard B. / Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults : The Strong Heart Study (SHS). In: American Heart Journal. 2006 ; Vol. 151, No. 2. pp. 412-418.
@article{5ba27b0d66734ce582408f9a1b2ca88a,
title = "Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: The Strong Heart Study (SHS)",
abstract = "Background: Echocardiographic left atrial (LA) volume has been documented to be an independent predictor of cardiovascular events. Less is known about the predictive ability of anteroposterior LA diameter, a simpler measure of LA size obtained routinely during echocardiographic evaluation. Methods: We investigated the prognostic value of LA diameter for incident cardiovascular events in 2804 American Indians free of clinical cardiovascular disease, valvular disease, and atrial fibrillation. Echocardiographic variables were obtained using standardized methods, and previously derived sex-specific partition values were used to define left ventricular (LV) hypertrophy indexed to height2.7 (in meters) and LA enlargement (>4.2 cm in men, >3.8 cm in women). Cardiovascular events included nonfatal stroke, coronary heart disease, congestive heart failure, and fatal cardiovascular disease based on validated definitions. Results: During a median follow-up of 7 years, 368 events occurred. LA diameter, both as a continuous and as a categorical variable, was significantly associated with incident cardiovascular events in unadjusted analyses. In multivariable analyses that adjusted for age, sex, body mass index, hypertension, diabetes, total cholesterol-high-density lipoprotein cholesterol, smoking, renal insufficiency, LV hypertrophy, abnormal LV systolic and diastolic function, mitral annular calcification, fibrinogen, and C-reactive protein, both LA diameter (risk ratio 1.04/mm, 95{\%} CI 1.02-1.07, P < .002) and LA enlargement (risk ratio 1.57, 95{\%} CI 1.17-2.10, P = .002) remained independent predictors of first cardiovascular events. Conclusions: In this population-based cohort, LA diameter independently predicted incident cardiovascular events after adjustment for established clinical, echocardiographic, and inflammatory risk factors. This simple measure of LA dilatation can identify individuals at heightened risk who may warrant more aggressive risk factor modification.",
author = "Jorge Kizer and Bella, {Jonathan N.} and Vittorio Palmieri and Liu, {Jennifer E.} and Best, {Lyle G.} and Lee, {Elisa T.} and Roman, {Mary J.} and Devereux, {Richard B.}",
year = "2006",
month = "2",
doi = "10.1016/j.ahj.2005.04.031",
language = "English (US)",
volume = "151",
pages = "412--418",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults

T2 - The Strong Heart Study (SHS)

AU - Kizer, Jorge

AU - Bella, Jonathan N.

AU - Palmieri, Vittorio

AU - Liu, Jennifer E.

AU - Best, Lyle G.

AU - Lee, Elisa T.

AU - Roman, Mary J.

AU - Devereux, Richard B.

PY - 2006/2

Y1 - 2006/2

N2 - Background: Echocardiographic left atrial (LA) volume has been documented to be an independent predictor of cardiovascular events. Less is known about the predictive ability of anteroposterior LA diameter, a simpler measure of LA size obtained routinely during echocardiographic evaluation. Methods: We investigated the prognostic value of LA diameter for incident cardiovascular events in 2804 American Indians free of clinical cardiovascular disease, valvular disease, and atrial fibrillation. Echocardiographic variables were obtained using standardized methods, and previously derived sex-specific partition values were used to define left ventricular (LV) hypertrophy indexed to height2.7 (in meters) and LA enlargement (>4.2 cm in men, >3.8 cm in women). Cardiovascular events included nonfatal stroke, coronary heart disease, congestive heart failure, and fatal cardiovascular disease based on validated definitions. Results: During a median follow-up of 7 years, 368 events occurred. LA diameter, both as a continuous and as a categorical variable, was significantly associated with incident cardiovascular events in unadjusted analyses. In multivariable analyses that adjusted for age, sex, body mass index, hypertension, diabetes, total cholesterol-high-density lipoprotein cholesterol, smoking, renal insufficiency, LV hypertrophy, abnormal LV systolic and diastolic function, mitral annular calcification, fibrinogen, and C-reactive protein, both LA diameter (risk ratio 1.04/mm, 95% CI 1.02-1.07, P < .002) and LA enlargement (risk ratio 1.57, 95% CI 1.17-2.10, P = .002) remained independent predictors of first cardiovascular events. Conclusions: In this population-based cohort, LA diameter independently predicted incident cardiovascular events after adjustment for established clinical, echocardiographic, and inflammatory risk factors. This simple measure of LA dilatation can identify individuals at heightened risk who may warrant more aggressive risk factor modification.

AB - Background: Echocardiographic left atrial (LA) volume has been documented to be an independent predictor of cardiovascular events. Less is known about the predictive ability of anteroposterior LA diameter, a simpler measure of LA size obtained routinely during echocardiographic evaluation. Methods: We investigated the prognostic value of LA diameter for incident cardiovascular events in 2804 American Indians free of clinical cardiovascular disease, valvular disease, and atrial fibrillation. Echocardiographic variables were obtained using standardized methods, and previously derived sex-specific partition values were used to define left ventricular (LV) hypertrophy indexed to height2.7 (in meters) and LA enlargement (>4.2 cm in men, >3.8 cm in women). Cardiovascular events included nonfatal stroke, coronary heart disease, congestive heart failure, and fatal cardiovascular disease based on validated definitions. Results: During a median follow-up of 7 years, 368 events occurred. LA diameter, both as a continuous and as a categorical variable, was significantly associated with incident cardiovascular events in unadjusted analyses. In multivariable analyses that adjusted for age, sex, body mass index, hypertension, diabetes, total cholesterol-high-density lipoprotein cholesterol, smoking, renal insufficiency, LV hypertrophy, abnormal LV systolic and diastolic function, mitral annular calcification, fibrinogen, and C-reactive protein, both LA diameter (risk ratio 1.04/mm, 95% CI 1.02-1.07, P < .002) and LA enlargement (risk ratio 1.57, 95% CI 1.17-2.10, P = .002) remained independent predictors of first cardiovascular events. Conclusions: In this population-based cohort, LA diameter independently predicted incident cardiovascular events after adjustment for established clinical, echocardiographic, and inflammatory risk factors. This simple measure of LA dilatation can identify individuals at heightened risk who may warrant more aggressive risk factor modification.

UR - http://www.scopus.com/inward/record.url?scp=31344471995&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=31344471995&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2005.04.031

DO - 10.1016/j.ahj.2005.04.031

M3 - Article

VL - 151

SP - 412

EP - 418

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 2

ER -