Author + information
- Sripal Bangalore, MD, MHA⁎ ( and )
- Farooq A. Chaudhry, MD, FACC
- ↵⁎Division of Cardiology, Columbia University College of Physicians and Surgeons, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, New York 10025
We agree with the comment of Dr. Goldberg about the relationships between atrial fibrillation (AF) and left atrial (LA) size. In the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) study of 4,060 patients with AF only 33% of patients had a normal LA size (1). Patients with dilated left atrium are more prone to AF, and patients with AF and a dilated left atrium are more likely to remain in AF than those with normal LA dimensions. Atrial fibrillation is also known to affect LA remodeling and geometry. In a prospective echocardiographic follow-up of patients with AF, atrial enlargement was shown to occur as a consequence of AF (2). Regardless of whether LA enlargement is a cause for or a consequence of AF, the prognosis is worse compared with patients with a normal LA size.
In our study cohort of 2,705 patients undergoing stress echocardiography (3), only 63 (2.3%) patients had either AF or atrial flutter. Analysis performed after excluding this cohort showed that LA size was able to further risk stratify patients undergoing stress echocardiography (Fig. 1). The results were similar for the multivariable analysis and incremental prognostic value analysis. Thus even after excluding patients with AF/atrial flutter, LA size provided independent and incremental value over standard risk factors, including left ventricular systolic dysfunction and ischemia, and was a powerful prognosticator. Therefore, it should be routinely used in the prognostic interpretation of stress echocardiography.
- American College of Cardiology Foundation
- Sanfilippo A.J.,
- Abascal V.M.,
- Sheehan M.,
- et al.
- Bangalore S.,
- Yao S.S.,
- Chaudhry F.A.