PMID- 24792737
OWN - NLM
STAT- MEDLINE
DCOM- 20140617
LR  - 20161125
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 113
IP  - 10
DP  - 2014 May 15
TI  - Relation of left atrial dysfunction to ischemic stroke in patients with coronary 
      heart disease (from the heart and soul study).
PG  - 1679-84
LID - S0002-9149(14)00713-9 [pii]
LID - 10.1016/j.amjcard.2014.02.021 [doi]
AB  - This study sought to determine whether left atrial (LA) dysfunction independently 
      predicts ischemic stroke. Atrial fibrillation (AF) impairs LA function and is 
      associated with ischemic stroke. However, ischemic stroke frequently occurs in 
      patients without known AF. The direct relation between LA function and risk of 
      ischemic stroke is unknown. We performed transthoracic echocardiography at rest 
      in 983 subjects with stable coronary heart disease. To quantify LA dysfunction, 
      we used the left atrial function index (LAFI), a validated formula incorporating 
      LA volumes at end-atrial systole and diastole. Cox proportional hazards models 
      were used to evaluate the association between LAFI and ischemic stroke or 
      transient ischemic attack (TIA). Over a mean follow-up of 7.1 years, 58 study 
      participants (5.9%) experienced an ischemic stroke or TIA. In patients without 
      known baseline AF or warfarin therapy (n = 893), participants in the lowest 
      quintile of LAFI had >3 times the risk of ischemic stroke or TIA (hazard ratio 
      3.3, 95% confidence interval 1.1 to 9.7, p = 0.03) compared with those in the 
      highest quintile. For each standard deviation (18.8 U) decrease in LAFI, the 
      hazard of ischemic stroke or TIA increased by 50% (hazard ratio 1.5, 95% 
      confidence interval 1.0 to 2.1, p = 0.04). Among measured echocardiographic 
      indexes of LA function, including LA volume, LAFI was the strongest predictor of 
      ischemic stroke or TIA. In conclusion, LA dysfunction is an independent risk 
      factor for stroke or TIA, even in patients without baseline AF.
CI  - Published by Elsevier Inc.
FAU - Wong, Jonathan M
AU  - Wong JM
AD  - Doris Duke Clinical Research Fellowship Program, University of California, San 
      Francisco, California; Department of Medicine, California Pacific Medical Center, 
      San Francisco, California.
FAU - Welles, Christine C
AU  - Welles CC
AD  - Veterans Affairs Medical Center, San Francisco, California; Department of 
      Medicine, University of California, San Francisco, San Francisco, California.
FAU - Azarbal, Farnaz
AU  - Azarbal F
AD  - Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 
      Stanford, California.
FAU - Whooley, Mary A
AU  - Whooley MA
AD  - Veterans Affairs Medical Center, San Francisco, California; Department of 
      Medicine, University of California, San Francisco, San Francisco, California; 
      Department of Epidemiology & Biostatistics, University of California, San 
      Francisco, San Francisco, California.
FAU - Schiller, Nelson B
AU  - Schiller NB
AD  - Veterans Affairs Medical Center, San Francisco, California; Division of 
      Cardiology, University of California, San Francisco, San Francisco, California.
FAU - Turakhia, Mintu P
AU  - Turakhia MP
AD  - Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 
      Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, 
      California. Electronic address: mintu@stanford.edu.
LA  - eng
GR  - R01 HL-079235/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20140303
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Aged
MH  - Atrial Fibrillation/*complications/diagnosis/physiopathology
MH  - Atrial Function, Left/*physiology
MH  - Brain Ischemia/diagnosis/epidemiology/*etiology
MH  - California/epidemiology
MH  - Coronary Disease/*complications/diagnosis/physiopathology
MH  - Echocardiography
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Atria/diagnostic imaging/*physiopathology
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Factors
MH  - Survival Rate/trends
MH  - Time Factors
EDAT- 2014/05/06 06:00
MHDA- 2014/06/18 06:00
CRDT- 2014/05/06 06:00
PHST- 2014/02/08 00:00 [received]
PHST- 2014/02/21 00:00 [revised]
PHST- 2014/02/21 00:00 [accepted]
PHST- 2014/05/06 06:00 [entrez]
PHST- 2014/05/06 06:00 [pubmed]
PHST- 2014/06/18 06:00 [medline]
AID - S0002-9149(14)00713-9 [pii]
AID - 10.1016/j.amjcard.2014.02.021 [doi]
PST - ppublish
SO  - Am J Cardiol. 2014 May 15;113(10):1679-84. doi: 10.1016/j.amjcard.2014.02.021. 
      Epub 2014 Mar 3.