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Prognostic importance of left atrial size measured by non-contrast cardiac computed tomography - A DANCAVAS study

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  • Maise Hoeigaard Fredgart, Department of Cardiology, Odense University Hospital, Denmark.
  • ,
  • Jes Sanddal Lindholt
  • Axel Brandes, Department of Cardiology, Odense University Hospital, Denmark.
  • ,
  • Flemming Hald Steffensen, Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark.
  • ,
  • Lars Frost
  • Jess Lambrechtsen, Department of Medicine, Odense University Hospital - Svendborg Hospital, Svendborg, Denmark.
  • ,
  • Marek Karon, Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
  • ,
  • Martin Busk, Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark.
  • ,
  • Grazina Urbonaviciene
  • Kenneth Egstrup, Department of Medicine, Odense University Hospital - Svendborg Hospital, Svendborg, Denmark.
  • ,
  • Axel Cosmus Pyndt Diederichsen, Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiology, Odense University Hospital, Odense, Denmark.

BACKGROUND: Enlargement of left atrium (LA) is a valuable marker of cardiovascular events, and LA size is readily available while performing non-contrast cardiac computed tomography (NCCT) for preventive purposes. We aimed to evaluate the predictive value of a single LA area from NCCT in a population-based cohort.

METHOD: Mainly men aged 60-75 years from DANCAVAS were included. Traditional risk factors were recorded, and an NCCT scan performed at baseline. Coronary artery calcifications (CAC) score and the largest LA area were measured. LA was indexed to body surface area and categorised into four groups. Data on incident atrial fibrillation (AF), thromboembolic events, heart failure (HF) and death were obtained from Danish national registries.

RESULTS: In total, 14,557 individuals were eligible, excluding those without LA measurement (N = 232) and with heart valve replacement (N = 197). Known AF or HF were respectively excluded from follow-up. Median follow-up time was 2.1 to 3.4 years. In total, 304 developed AF, 149 had thromboembolism, 129 developed HF and 482 died. In adjusted analysis, LA enlargement was associated with AF (HR (95% CI): large 1.99 (1.46-2.71) and very large LA 3.77 (2.31-6.14)) and HF (large 2.40 (1.50-3.85) and very large LA 6.54 (4.07-10.51)). A very large LA significantly increased mortality (HR: 2.01 (1.44-2.82)), and was associated with a two-fold increased risk of thromboembolism; however, not significantly in adjusted analysis (p = 0.09).

CONCLUSION: We demonstrated that determination of LA area from NCCT was an important predictor of AF, HF and death. This knowledge could inform current risk assessment beyond CAC score.

Original languageEnglish
JournalInternational Journal of Cardiology
Volume328
Pages (from-to)220-226
Number of pages7
ISSN0167-5273
DOIs
Publication statusPublished - Apr 2021

    Research areas

  • All cause death, Atrial fibrillation, Heart failure, Left atrial size, Non-contrast cardiac computed tomography, Thromboembolism

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