Maise Hoeigaard Fredgart1, Jes Sanddal Lindholt2, Axel Brandes3, Flemming Hald Steffensen4, Lars Frost5, Jess Lambrechtsen6, Marek Karon7, Martin Busk4, Grazina Urbonaviciene5, Kenneth Egstrup6, Axel Cosmus Pyndt Diederichsen8. 1. Department of Cardiology, Odense University Hospital, Odense, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. Electronic address: Maise.Hoigaard.Fredgart@rsyd.dk. 2. Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Cardiovascular Centre of Excellence (CAVAC), Denmark; Odense University Hospital, Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark. 3. Department of Cardiology, Odense University Hospital, Odense, Denmark. 4. Department of Cardiology, Sygehus Lillebaelt, Vejle, Denmark. 5. Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark. 6. Department of Cardiology, Svendborg Hospital, Svendborg, Denmark. 7. Department of Medicine, Nykoebing Falster Hospital, Nykoebing Falster, Denmark. 8. Department of Cardiology, Odense University Hospital, Odense, Denmark; Odense University Hospital, Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark.
Abstract
BACKGROUND: Enlargement of left atrium (LA) is a valuable marker of cardiovascular events, and LA size is readily available while performing non-contrast cardiac computed tomography (NCCT) for preventive purposes. We aimed to evaluate the predictive value of a single LA area from NCCT in a population-based cohort. METHOD: Mainly men aged 60-75 years from DANCAVAS were included. Traditional risk factors were recorded, and an NCCT scan performed at baseline. Coronary artery calcifications (CAC) score and the largest LA area were measured. LA was indexed to body surface area and categorised into four groups. Data on incident atrial fibrillation (AF), thromboembolic events, heart failure (HF) and death were obtained from Danish national registries. RESULTS: In total, 14,557 individuals were eligible, excluding those without LA measurement (N = 232) and with heart valve replacement (N = 197). Known AF or HF were respectively excluded from follow-up. Median follow-up time was 2.1 to 3.4 years. In total, 304 developed AF, 149 had thromboembolism, 129 developed HF and 482 died. In adjusted analysis, LA enlargement was associated with AF (HR (95% CI): large 1.99 (1.46-2.71) and very large LA 3.77 (2.31-6.14)) and HF (large 2.40 (1.50-3.85) and very large LA 6.54 (4.07-10.51)). A very large LA significantly increased mortality (HR: 2.01 (1.44-2.82)), and was associated with a two-fold increased risk of thromboembolism; however, not significantly in adjusted analysis (p = 0.09). CONCLUSION: We demonstrated that determination of LA area from NCCT was an important predictor of AF, HF and death. This knowledge could inform current risk assessment beyond CAC score.
BACKGROUND: Enlargement of left atrium (LA) is a valuable marker of cardiovascular events, and LA size is readily available while performing non-contrast cardiac computed tomography (NCCT) for preventive purposes. We aimed to evaluate the predictive value of a single LA area from NCCT in a population-based cohort. METHOD: Mainly men aged 60-75 years from DANCAVAS were included. Traditional risk factors were recorded, and an NCCT scan performed at baseline. Coronary artery calcifications (CAC) score and the largest LA area were measured. LA was indexed to body surface area and categorised into four groups. Data on incident atrial fibrillation (AF), thromboembolic events, heart failure (HF) and death were obtained from Danish national registries. RESULTS: In total, 14,557 individuals were eligible, excluding those without LA measurement (N = 232) and with heart valve replacement (N = 197). Known AF or HF were respectively excluded from follow-up. Median follow-up time was 2.1 to 3.4 years. In total, 304 developed AF, 149 had thromboembolism, 129 developed HF and 482 died. In adjusted analysis, LA enlargement was associated with AF (HR (95% CI): large 1.99 (1.46-2.71) and very large LA 3.77 (2.31-6.14)) and HF (large 2.40 (1.50-3.85) and very large LA 6.54 (4.07-10.51)). A very large LA significantly increased mortality (HR: 2.01 (1.44-2.82)), and was associated with a two-fold increased risk of thromboembolism; however, not significantly in adjusted analysis (p = 0.09). CONCLUSION: We demonstrated that determination of LA area from NCCT was an important predictor of AF, HF and death. This knowledge could inform current risk assessment beyond CAC score.
Authors: Masahiko Asami; Stephan Dobner; Stefan Stortecky; Dik Heg; Fabien Praz; Jonas Lanz; Taishi Okuno; Daijiro Tomii; David Reineke; Stephan Windecker; Thomas Pilgrim Journal: Catheter Cardiovasc Interv Date: 2022-02-16 Impact factor: 2.585