CORRESPONDENCE: LETTER TO THE EDITOR
Relationship Between Atrial Fibrillation and Left Atrial Size
Ythan H. Goldberg, MD*
* Department of Cardiology, Montefiore Medical Center, 111 East 210th Street, Silver Zone, 2nd Floor, Bronx, New York 10467 (Email: ygoldber{at}montefiore.org).
The paper by Bangalore et al. (1) in a recent issue of the Journal evaluated the role of diastolic dysfunction as measured by left atrial (LA) size and the associated risk for adverse cardiovascular events in patients undergoing stress echocardiography. The authors report indexed LA size as a predictor of cardiac events independent of traditional clinical risk factors. Patients with significant mitral valve disease and with significant left ventricular systolic dysfunction were appropriately excluded from this study. However, atrial fibrillation (AF) is another important potential confounder, because is it known to affect LA remodeling and geometry (2) and is a known risk factor for cardiovascular events, particularly stroke. This remodeling effect is independent of loading conditions within the LA and can occur in both chronic and paroxysmal AF (3). It would be important to know whether AF was included in the multivariate analysis as well as the percent of patients who carried the diagnosis of AF. Furthermore, if LA size could predict prognosis in the subgroup of patients without AF to a similar extent as that reported in this study, this would lend further validity to the authors’ argument to incorporate LA size into the prognostic interpretation of stress testing.
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1. Bangalore S, Yao SS, Chaudhry FA. Role of left atrial size in risk stratification and prognosis of patients undergoing stress echocardiography J Am Coll Cardiol 2007;50:1254-1262.[Abstract/Free Full Text]2. Sanfilippo AJ, Abascal VM, Sheehan M, et al. Atrial enlargement as a consequence of atrial fibrillationA prospective echocardiographic study. Circulation 1990;82:792-797.[Abstract/Free Full Text] 3. Phang RS, Isserman SM, Karia D, et al. Echocardiographic evidence of left atrial abnormality in young patients with lone paroxysmal atrial fibrillation Am J Cardiol 2004;94:511-513.[CrossRef][Web of Science][Medline]
Related Article
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Reply
- Sripal Bangalore and Farooq A. Chaudhry
J. Am. Coll. Cardiol. 2008 51: 776-777.
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