Left atrial enlargement and 1-year cerebrovascular events in subjects without atrial fibrillation: A prospective cohort study

Objectives Left atrial enlargement (LAE) is a cardiac structural abnormality linked to adverse cardiovascular events, including stroke. However, its independent prognostic role in patients without atrial fibrillation (AF) remains unclear. Design prospective cohort study. Setting three teaching hospitals in Milan, Italy. Participants consecutive adults undergoing transthoracic echocardiography (TTE) between 2012 and 2023. Patients with a history of AF or receiving anticoagulant therapy (for any indication) were excluded. Interventions participants underwent TTE in the context of standard clinical practice. Main outcome measures LAE was categorized by left atrial volume index (LAVi) as absent (≤34 mL/m²), mild (>34 and ≤41 mL/m²), moderate (>41 and ≤48 mL/m²), or severe (>48 mL/m²). The primary outcome was a composite of cerebrovascular events (CVEs), including ischemic stroke or transient ischemic attack (TIA), within 1 year of the index echocardiogram. Multivariate logistic regression models were used to evaluate the independent association of LAE with 1-year CVEs. Results We included 53,109 subjects with a median age of 66 years (48 % female). CVEs occurred in 1318 subjects (2.5 %). In the multivariate analysis, all categories of LAE were associated with 1-year CVEs compared with no LAE (mild: OR 1.21, 95 % CI 1.03 to 1.43; moderate: OR 1.48, 95 % CI 1.20 to 1.83; severe: OR 1.85, 95 % CI 1.54 to 2.22). This association was independent of other relevant predictors. Conclusions LAE defined by LAVi is associated with 1-year CVEs in subjects without known AF and ongoing anticoagulation, suggesting that LAVi can serve as a marker to refine CVE risk stratification.