Increased left atrial volume index: potent biomarker for first-ever ischemic stroke

OBJECTIVE: To establish the incidence and correlation of increased left atrial volume index (LAVI) in patients with first-ever ischemic stroke. PARTICIPANTS AND METHODS: Using our institution's epidemiological database, we defined a cohort of 432 patients (cases) who underwent transthoracic echocardiography within 60 days of first ischemic stroke between January 1, 1985, and December 31, 1994. Left atrial volume was measured with the biplane area-length method, indexed to body surface area (LAVI, expressed as mL/m ²). The control group consisted of 416 community residents who underwent transthoracic echocardiography as participants in a stroke risk factor study. Increased LAVI was defined as 28 mL/m² or higher. Survival in patients was compared with expected survival among white Minnesotans and was further modeled as a function of age, sex, LAVI, and clinical risk factors. RESULTS: Among the included 306 patients, 230 (75%) had increased LAVI (mean ± SD, 49±21 mL/m²). Patients with increased LAVI were older than those with normal LAVI (mean ± SD age, 76±11 vs 71±13 years; P=.003) and had more cardiovascular risk factors (mean ± SD number, 1.8±0.07 vs 1.3±0.89; P<.001). Mean LAVI was higher in cases than in age- and sex-matched controls ( P<.001). At 5-year follow-up, cases showed excess mortality compared with age-matched controls ( P=.001). After variables were adjusted for age, sex, and clinical risk factors, LAVI was independently associated with mortality. CONCLUSION: A useful index for prediction of adverse cardiovascular events, LAVI might also predict first ischemic stroke and subsequent mortality.