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Enlarged left atrial diameter confers higher risk for CV death in women with AF
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Women with atrial fibrillation are more likely to have enlarged left atrial diameter, and patients with atrial fibrillation and enlarged left atrial diameter, particularly women, are at increased risk for CV death, recent findings show.
According to the study background, women are at increased risk for thromboembolism related to AF, left atrial diameter is an independent predictor of major CV events in the general population, and enlargement of the left atrial is associated with incident and recurrent AF. Therefore, the researchers studied whether there is a relationship between sex, left atrial enlargement and CV death in patients with AF.
In a post-hoc analysis of the AFFIRM trial, Marco Proietti, MD, and colleagues analyzed 2,615 patients with AF and available data on left atrial dimension.
They found that 1,751 patients (67%; mean age, 71 years; 41.5% women) had an enlarged left atrial diameter compared with 864 patients (33%; mean age, 70 years; 37.2% women) who had normal left atrial diameter. Enlarged left atrial diameter was more common in women (P = .032), they wrote.
Compared with those with normal left atrial diameter, those with enlarged left atrial diameter had higher BMI (28.8 kg/m2 vs. 26.8 kg/m2; P < .001) and a higher rate of hypertension (74.5% vs. 65.6%; P < .001), diabetes (20.9% vs. 16.3%; P = .005), HF (27.8% vs. 13.7%; P < .001), prior CAD (37.5% vs. 31.2%; P = .002) and valvular disease (14.6% vs. 8.7%; P < .001), according to the researchers.
They determined that BMI (OR = 1.05; 95% CI, 1.02-1.07), left ventricular mass (OR = 1.01; 95% CI, 1-1.01), female sex (OR = 1.73; 95% CI, 1.32-2.28) and mitral valve insufficiency (OR = 3.04; 95% CI, 2.1-4.39) all were associated with enlargement of the left atrial.
Further analysis indicated that women with AF and left atrial enlargement had increased risk for CV death (P = .011), increase in left atrial diameter was associated with CV death (P < .001) and left atrial diameter was an independent predictor for CV death in women with AF (HR = 2.28; 95% CI, 1.33-3.9).
“Overall, these findings emphasize the role of [left atrial] size in the prognosis assessment of AF patients, beyond AF risk of recurrence and/or stroke, and underscore the clinical relevance of [left atrial] measurement to predict CV death, particularly in female AF patients,” Proietti, from University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom, and colleagues wrote. – by Erik Swain
Disclosure: One researcher reports receiving consulting and/or speaking fees from Astellas, Bayer/Janssen Pharmaceuticals, Biotronik, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi Sankyo, Medtronic, Merck, Microlife, Portola, Roche and Sanofi.
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