Abstract 14713: Left Atrial Diameter Predicts Mortaliy in African Americans with Hypertension
Introduction: Left atrial (LA) dilatation has been shown to be a predictor of adverse outcomes in Caucasian patients with hypertension and other forms of heart disease. Less is known about the prognostic value of LA size in African Americans (AfrAm) and there is evidence that LA remodeling is relatively reduced in AfrAm with heart disease. We investigated the prognostic value of single plane LA dimension in hypertensive AfrAm.
Methods: Clinical data and two-dimensional echocardiographic measurements were obtained in 583 consecutive AfrAm (mean ejection fraction = 58.6 ± 9.9%) with hypertension undergoing stress echocardiography at an urban community hospital. LA systolic diameter was measured as the maximum dimension in the parasternal long or short-axis view and indexed to body surface area (BSA). Patients were followed for mortality. ROC analysis was used to determine the best predictor of LA size for mortality and Cox regression was used to determine clinical and echocardiographic predictors of mortality.
Results: LA size above normal values (≥ 2.4 cm/m2 according to the American Society of Echocardiography guidelines) was found in 9.5% of all patients. During follow-up of 4.5 ± 1.7 years, 85 patients (14.6%) died. LA size had an area under the curve of 0.72 with the best cutoff value of 2.05 cm/m2. Cox analysis showed that LA size ≥ 2.05 cm/m2 (p = 0.013, HR 1.85 [1.14–3.01]), age (p <0.001, HR 1.041 [1.021–1.061]), tobacco use (p <0.001, HR 2.77 [1.62–4.74]), elevated left ventricular mass index (p <0.001, HR 2.51 [1.59–3.96]), and an abnormal stress echocardiogram (p = 0.002, HR 2.057 [1.31–3.24]) were predictive on multivariate analysis.
Conclusions: LA dilatation is relatively infrequent in hypertensive AfrAm patients when published normal values are used. Single plane LA dimension indexed for BSA has reasonable accuracy for prediction of mortality with the best threshold value residing well within the normal range. LA size was an independent predictor of mortality.
- © 2010 by American Heart Association, Inc.