Left atrial size and the risk of ischemic stroke in an ethnically mixed population
Left atrial size and the risk of ischemic stroke in an ethnically mixed population
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DOI：
10.1161/01.str.30.10.2019
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发表时间：
1999-10-01
期刊：
影响因子：
8.3
通讯作者：
Homma, S
中科院分区：
文献类型：
--
作者：
Di Tullio, MR;Sacco, RL;Homma, S
背景和目的：左心房大小与缺血性脑卒中之间的关系是有争议的，并被认为仅存在于男性中，并由左心室质量介导。数据几乎只适用于白人患者。本研究的目的是评估多民族人群左心房大小与缺血性卒中之间的关系。方法：一项基于人群的病例对照研究，对352例年龄在bb0 ~ 39岁的首次缺血性卒中患者和369例年龄、性别和种族匹配的社区对照组进行了研究。采用二维经胸超声心动图测量左房内径，以体表面积为指标。在校正其他卒中危险因素后，采用条件logistic回归分析来评估与左房指数相关的卒中风险在整个组中以及在年龄、性别和种族族裔阶层中。结果：整体组左心房指数与缺血性卒中相关(调整后的OR为1.47 / 10 mm/1.7 m(2)体表面积；95% CI 1.03 - 2.11)。这种关联在男性中存在（校正OR 2.81, 95% CI 1.42 - 5.57），但在女性中不存在（校正OR 1.08, 95% CI 0.70 - 1.66），在60岁患者中不存在（校正OR 1.23, 95% CI 0.84 - 1.81）。亚组分析显示，风险存在于所有年龄组的男性中。在女性中，左心室肥厚对左房指数和中风之间缺乏相关性的影响最大。左房指数与卒中之间的关联趋势在白人（调整OR 1.81, 95% CI 0.81至4.09）和西班牙裔（调整OR 1.61, 95% CI 0.98至2.65）中观察到，但在黑人中不太明显（调整OR 1.25, 95% CI 0.74至2.14）。结论：在调整了包括左室肥厚在内的其他卒中危险因素后，左房扩大与缺血性卒中风险增加相关。在所有年龄段的男性中都观察到这种关联，而在女性中，它因其他因素而减弱，尤其是左心室肥厚。中风风险的种族差异可能存在，需要进一步调查。
Background and Purpose-The association between left atrial size and ischemic stroke is controversial and has been suggested to exist only in men and to be mediated by left ventricular mass. Data are available almost exclusively for white patients. The purpose of this study was to evaluate the association between left atrial size and ischemic stroke in a multiethnic population.Methods-A population-based case-control study was conducted in 352 patients aged >39 years with first ischemic stroke and in 369 age-, gender-, and race-ethnicity-matched community controls. Left atrial diameter was measured by 2-dimensional transthoracic echocardiography and indexed by body surface area. Conditional logistic regression analysis was performed to assess the risk of stroke associated with left atrial index in the overall group and in the age, gender, and race-ethnic strata after adjustment for the presence of other stroke risk factors.Results-Left atrial index was associated with ischemic stroke in the overall group (adjusted OR 1.47 per 10 mm/1.7 m(2) of body surface area; 95% CI 1.03 to 2.11). The association was present in men (adjusted OR 2.81, 95% CI 1.42 to 5.57) but not in women (adjusted OR 1.08, 95% CI 0.70 to 1.66), and in patients aged 60 years (adjusted OR 1.23, 95% CI 0.84 to 1.81). Subgroup analyses showed the risk to be present in men across all age subgroups. In women, the lack of association between left atrial index and stroke was most strongly influenced by left ventricular hypertrophy. A trend toward an association between left atrial index and stroke was observed in whites (adjusted OR 1.81, 95% CI 0.81 to 4.09) and Hispanics (adjusted OR 1.61, 95% CI 0.98 to 2.65) but was less evident in blacks (adjusted OR 1.25, 95% CI 0.74 to 2.14).Conclusions-Left atrial enlargement is associated with an increased risk of ischemic stroke after adjustment for other stroke risk factors, including left ventricular hypertrophy. The association is observed in men of all ages, whereas in women it is attenuated by other factors, especially left ventricular hypertrophy. interracial differences in the stroke risk may exist that need further investigation.