Correlation Of Left Atrial Size With Ischemic Stroke In Patients With Stable Coronary Artery Disease

Objective:Coronary artery disease is a major cause of mortality and morbidity worldwide. Chronic myocardial ischemia results in myocardial remodeling. Structural change of atrial size is common. The studies have demonstrated the association between atrial size and ischemic stroke in general population. Hence, we explored the association between left atrial dimension and ischemic stroke in patients with stable coronary artery disease.Methods:The patients with stable coronary artery disease hospitalized with first ischemic stroke were collected from the database of the Second Affiliated Hospital of Zhejiang University School of Medicine between January2013and January2015.142patients with ischemic stroke were enrolled as stroke group.151patients with stable coronary artery disease but without stroke were enrolled as control group. We collected patients’ clinic basic characteristics including gender, age, height, weight, smoking status, history of hypertension, diabetes, myocardial infarction, atrial fibrillation/atrial flutter and medication usage including antiplatelet drugs, anticoagulant drugs, diuretic, aldosterone-receptor antagonists, ACEI/ARB and beta-blockers, the laboratory data including fasting blood glucose, glycosylated hemoglobin, low density lipoprotein and high density lipoprotein; Echocardiographic data include left ventricular ejection fraction, left atrial diameter (LAD), left ventricular internal end-diastolic diameter, interventricular septal thickness, and left ventricular posterior wall thickness; LAD indexed by body mass index (BMI) or body surface area (BSA) indicated as LADIBMI or LADIBSA respectively. Univariate ananlysis was used to compare LAD, LADIBMI and LADIBSA between stroke group and control group. ROC analysis was performed to identify the parameter associated with stroke most closely. A multivariate Logistic regression analysis was used to identify independent risks of ischemic stroke. Finally, we perform subgroup analysis according to atrial fibrillation/atrial flutter and gender.Results:In stroke group, the patients were older; LAD, LADIBSA and LADIBMI were significantly higher, and the incidence of diabetes, hypertension and atrial fibrillation/atrial flutter were significantly higher compared to control group;(P<0.05). ROC analysis showed that LADIBSA was associated with the highest area under curve compared to other parameters. Adjusted for age, smoking status, renal insufficiency, family history of stroke, history of hypertension, diabetes, and atrial fibrillation/atrial flutter, LADIBSA was not associated with ischemic stroke in patients with stable coronary heart disease. The results are consistent in subgroup analysis according to genders. However, In patients with stable coronary artery disease but without atrial fibrillation/atrial flutter, we found that LADIBSA is an independent risk factor of ischemic stroke (OR=1.27;95%CI:1.16-1.37; P=0.002); In these patients, the results of subgroup analysis based on genders showed that for lmm/m2decrease in LADIBSA, the hazard of ischemia stroke increased by40%in male (OR=1.40;95%CI:1.22-1.61; P=0.001) and20%in female (OR=1.20;95%CI:1.02-1.42; P=0.028)Conclusion:In patients with stable coronary artery disease but without atrial fibrillation, LADIBSA was associated with ischemic stroke in both genders...