Left Atrial Enlargement and Stroke Recurrence

The Northern Manhattan Stroke Study

Shadi Yaghi, Yeseon P. Moon, Consuelo Mora-Mclaughlin, Joshua Z. Willey, Ken Cheung, Marco R. Di Tullio, Shunichi Homma, Hooman Kamel, Ralph L Sacco, Mitchell S V Elkind

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Background and Purpose-Although left atrial enlargement (LAE) increases incident stroke risk, the association with recurrent stroke is less clear. Our aim was to determine the association of LAE with recurrent stroke most likely related to embolism (cryptogenic and cardioembolic) and all ischemic stroke recurrences. Methods-We followed 655 first ischemic stroke patients in the Northern Manhattan Stroke Study for ≤5 years. LA size from 2D echocardiography was categorized as normal LAE (52.7%), mild LAE (31.6%), and moderate-severe LAE (15.7%). We used Cox proportional hazard models to calculate the hazard ratios and 95% confidence intervals for the association of LA size and LAE with recurrent cryptogenic/cardioembolic and total recurrent ischemic stroke. Results-LA size was available in 529 (81%) patients. Mean age at enrollment was 69±13 years; 45.8% were male, 54.0% Hispanic, and 18.5% had atrial fibrillation. Over a median of 4 years, there were 65 recurrent ischemic strokes (29 were cardioembolic or cryptogenic). In multivariable models adjusted for confounders, including atrial fibrillation and heart failure, moderate-severe LAE compared with normal LA size was associated with greater risk of recurrent cardioembolic/cryptogenic stroke (adjusted hazard ratio 2.83, 95% confidence interval 1.03-7.81), but not total ischemic stroke (adjusted hazard ratio 1.06, 95% confidence interval, 0.48-2.30). Mild LAE was not associated with recurrent stroke. Conclusion-Moderate to severe LAE was an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Further research is needed to determine whether anticoagulant use may reduce risk of recurrence in ischemic stroke patients with moderate to severe LAE.

Original languageEnglish (US)
Pages (from-to)1488-1493
Number of pages6
JournalStroke
Volume46
Issue number6
DOIs
StatePublished - Jun 4 2015

Fingerprint

Stroke
Recurrence
Confidence Intervals
Atrial Fibrillation
Embolism
Hispanic Americans
Proportional Hazards Models
Anticoagulants
Echocardiography
Heart Failure

Keywords

  • embolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Yaghi, S., Moon, Y. P., Mora-Mclaughlin, C., Willey, J. Z., Cheung, K., Di Tullio, M. R., ... Elkind, M. S. V. (2015). Left Atrial Enlargement and Stroke Recurrence: The Northern Manhattan Stroke Study. Stroke, 46(6), 1488-1493. https://doi.org/10.1161/STROKEAHA.115.008711

Left Atrial Enlargement and Stroke Recurrence : The Northern Manhattan Stroke Study. / Yaghi, Shadi; Moon, Yeseon P.; Mora-Mclaughlin, Consuelo; Willey, Joshua Z.; Cheung, Ken; Di Tullio, Marco R.; Homma, Shunichi; Kamel, Hooman; Sacco, Ralph L; Elkind, Mitchell S V.

In: Stroke, Vol. 46, No. 6, 04.06.2015, p. 1488-1493.

Research output: Contribution to journalArticle

Yaghi, S, Moon, YP, Mora-Mclaughlin, C, Willey, JZ, Cheung, K, Di Tullio, MR, Homma, S, Kamel, H, Sacco, RL & Elkind, MSV 2015, 'Left Atrial Enlargement and Stroke Recurrence: The Northern Manhattan Stroke Study', Stroke, vol. 46, no. 6, pp. 1488-1493. https://doi.org/10.1161/STROKEAHA.115.008711
Yaghi S, Moon YP, Mora-Mclaughlin C, Willey JZ, Cheung K, Di Tullio MR et al. Left Atrial Enlargement and Stroke Recurrence: The Northern Manhattan Stroke Study. Stroke. 2015 Jun 4;46(6):1488-1493. https://doi.org/10.1161/STROKEAHA.115.008711
Yaghi, Shadi ; Moon, Yeseon P. ; Mora-Mclaughlin, Consuelo ; Willey, Joshua Z. ; Cheung, Ken ; Di Tullio, Marco R. ; Homma, Shunichi ; Kamel, Hooman ; Sacco, Ralph L ; Elkind, Mitchell S V. / Left Atrial Enlargement and Stroke Recurrence : The Northern Manhattan Stroke Study. In: Stroke. 2015 ; Vol. 46, No. 6. pp. 1488-1493.
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abstract = "Background and Purpose-Although left atrial enlargement (LAE) increases incident stroke risk, the association with recurrent stroke is less clear. Our aim was to determine the association of LAE with recurrent stroke most likely related to embolism (cryptogenic and cardioembolic) and all ischemic stroke recurrences. Methods-We followed 655 first ischemic stroke patients in the Northern Manhattan Stroke Study for ≤5 years. LA size from 2D echocardiography was categorized as normal LAE (52.7{\%}), mild LAE (31.6{\%}), and moderate-severe LAE (15.7{\%}). We used Cox proportional hazard models to calculate the hazard ratios and 95{\%} confidence intervals for the association of LA size and LAE with recurrent cryptogenic/cardioembolic and total recurrent ischemic stroke. Results-LA size was available in 529 (81{\%}) patients. Mean age at enrollment was 69±13 years; 45.8{\%} were male, 54.0{\%} Hispanic, and 18.5{\%} had atrial fibrillation. Over a median of 4 years, there were 65 recurrent ischemic strokes (29 were cardioembolic or cryptogenic). In multivariable models adjusted for confounders, including atrial fibrillation and heart failure, moderate-severe LAE compared with normal LA size was associated with greater risk of recurrent cardioembolic/cryptogenic stroke (adjusted hazard ratio 2.83, 95{\%} confidence interval 1.03-7.81), but not total ischemic stroke (adjusted hazard ratio 1.06, 95{\%} confidence interval, 0.48-2.30). Mild LAE was not associated with recurrent stroke. Conclusion-Moderate to severe LAE was an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Further research is needed to determine whether anticoagulant use may reduce risk of recurrence in ischemic stroke patients with moderate to severe LAE.",
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AU - Willey, Joshua Z.

AU - Cheung, Ken

AU - Di Tullio, Marco R.

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AU - Sacco, Ralph L

AU - Elkind, Mitchell S V

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N2 - Background and Purpose-Although left atrial enlargement (LAE) increases incident stroke risk, the association with recurrent stroke is less clear. Our aim was to determine the association of LAE with recurrent stroke most likely related to embolism (cryptogenic and cardioembolic) and all ischemic stroke recurrences. Methods-We followed 655 first ischemic stroke patients in the Northern Manhattan Stroke Study for ≤5 years. LA size from 2D echocardiography was categorized as normal LAE (52.7%), mild LAE (31.6%), and moderate-severe LAE (15.7%). We used Cox proportional hazard models to calculate the hazard ratios and 95% confidence intervals for the association of LA size and LAE with recurrent cryptogenic/cardioembolic and total recurrent ischemic stroke. Results-LA size was available in 529 (81%) patients. Mean age at enrollment was 69±13 years; 45.8% were male, 54.0% Hispanic, and 18.5% had atrial fibrillation. Over a median of 4 years, there were 65 recurrent ischemic strokes (29 were cardioembolic or cryptogenic). In multivariable models adjusted for confounders, including atrial fibrillation and heart failure, moderate-severe LAE compared with normal LA size was associated with greater risk of recurrent cardioembolic/cryptogenic stroke (adjusted hazard ratio 2.83, 95% confidence interval 1.03-7.81), but not total ischemic stroke (adjusted hazard ratio 1.06, 95% confidence interval, 0.48-2.30). Mild LAE was not associated with recurrent stroke. Conclusion-Moderate to severe LAE was an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Further research is needed to determine whether anticoagulant use may reduce risk of recurrence in ischemic stroke patients with moderate to severe LAE.

AB - Background and Purpose-Although left atrial enlargement (LAE) increases incident stroke risk, the association with recurrent stroke is less clear. Our aim was to determine the association of LAE with recurrent stroke most likely related to embolism (cryptogenic and cardioembolic) and all ischemic stroke recurrences. Methods-We followed 655 first ischemic stroke patients in the Northern Manhattan Stroke Study for ≤5 years. LA size from 2D echocardiography was categorized as normal LAE (52.7%), mild LAE (31.6%), and moderate-severe LAE (15.7%). We used Cox proportional hazard models to calculate the hazard ratios and 95% confidence intervals for the association of LA size and LAE with recurrent cryptogenic/cardioembolic and total recurrent ischemic stroke. Results-LA size was available in 529 (81%) patients. Mean age at enrollment was 69±13 years; 45.8% were male, 54.0% Hispanic, and 18.5% had atrial fibrillation. Over a median of 4 years, there were 65 recurrent ischemic strokes (29 were cardioembolic or cryptogenic). In multivariable models adjusted for confounders, including atrial fibrillation and heart failure, moderate-severe LAE compared with normal LA size was associated with greater risk of recurrent cardioembolic/cryptogenic stroke (adjusted hazard ratio 2.83, 95% confidence interval 1.03-7.81), but not total ischemic stroke (adjusted hazard ratio 1.06, 95% confidence interval, 0.48-2.30). Mild LAE was not associated with recurrent stroke. Conclusion-Moderate to severe LAE was an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Further research is needed to determine whether anticoagulant use may reduce risk of recurrence in ischemic stroke patients with moderate to severe LAE.

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