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Left atrial dimension and traditional cardiovascular risk factors predict 20-year clinical cardiovascular events in young healthy adults: the CARDIA study.
Armstrong, Anderson C; Liu, Kiang; Lewis, Cora E; Sidney, Stephen; Colangelo, Laura A; Kishi, Satoru; Ambale-Venkatesh, Bharath; Arynchyn, Alex; Jacobs, David R; Correia, Luís C L; Gidding, Samuel S; Lima, João A C.
Afiliação
  • Armstrong AC; Department of Cardiology/Cardiovascular Imaging, Johns Hopkins University, 600 N. Wolfe Street/Blalock 524, Baltimore, MD 21287-0409, USA Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil.
  • Liu K; Northwestern University, Chicago, IL, USA.
  • Lewis CE; University of Alabama at Birmingham, Birmingham, AL, USA.
  • Sidney S; Kaiser Permanente, Oakland, CA, USA.
  • Colangelo LA; Northwestern University, Chicago, IL, USA.
  • Kishi S; Department of Cardiology/Cardiovascular Imaging, Johns Hopkins University, 600 N. Wolfe Street/Blalock 524, Baltimore, MD 21287-0409, USA.
  • Ambale-Venkatesh B; Department of Cardiology/Cardiovascular Imaging, Johns Hopkins University, 600 N. Wolfe Street/Blalock 524, Baltimore, MD 21287-0409, USA.
  • Arynchyn A; University of Alabama at Birmingham, Birmingham, AL, USA.
  • Jacobs DR; University of Minnesota, Minneapolis, MN, USA.
  • Correia LC; Escola Bahiana de Medicina, Salvador, BA, Brazil.
  • Gidding SS; Nemours Cardiac Center, Wilmington, DE, USA.
  • Lima JA; Department of Cardiology/Cardiovascular Imaging, Johns Hopkins University, 600 N. Wolfe Street/Blalock 524, Baltimore, MD 21287-0409, USA jlima@jhmi.edu.
Eur Heart J Cardiovasc Imaging ; 15(8): 893-9, 2014 Aug.
Article em En | MEDLINE | ID: mdl-24534011
AIMS: We investigated whether the addition of left atrial (LA) size determined by echocardiography improves cardiovascular risk prediction in young adults over and above the clinically established Framingham 10-year global CV risk score (FRS). METHODS AND RESULTS: We included white and black CARDIA participants who had echocardiograms in Year-5 examination (1990-91). The combined endpoint after 20 years was incident fatal or non-fatal cardiovascular disease: myocardial infarction, heart failure, cerebrovascular disease, peripheral artery disease, and atrial fibrillation/flutter. Echocardiography-derived M-mode LA diameter (LAD; n = 4082; 149 events) and 2D four-chamber LA area (LAA; n = 2412; 77 events) were then indexed by height or body surface area (BSA). We used Cox regression, areas under the receiver operating characteristic curves (AUC), and net reclassification improvement (NRI) to assess the prediction power of LA size when added to calculated FRS or FRS covariates. The LAD and LAA cohorts had similar characteristics; mean LAD/height was 2.1 ± 0.3 mm/m and LAA/height 9.3 ± 2.0 mm(2)/m. After indexing by height and adjusting for FRS covariates, hazard ratios were 1.31 (95% CI 1.12, 1.60) and 1.43 (95% CI 1.13, 1.80) for LAD and LAA, respectively; AUC was 0.77 for LAD and 0.78 for LAA. When LAD and LAA were indexed to BSA, the results were similar but slightly inferior. Both LAD and LAA showed modest reclassification ability, with non-significant NRIs. CONCLUSION: LA size measurements independently predict clinical outcomes. However, it only improves discrimination over clinical parameters modestly without altering risk classification. Indexing LA size by height is at least as robust as by BSA. Further research is needed to assess subgroups of young adults who may benefit from LA size information in risk stratification.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Átrios do Coração Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Limite: Adult / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Eur Heart J Cardiovasc Imaging Ano de publicação: 2014 Tipo de documento: Article País de afiliação: Brasil País de publicação: Reino Unido
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Átrios do Coração Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Limite: Adult / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Eur Heart J Cardiovasc Imaging Ano de publicação: 2014 Tipo de documento: Article País de afiliação: Brasil País de publicação: Reino Unido