Atrial Cardiopathy in the Absence of Atrial Fibrillation Increases Risk of Ischemic Stroke, Incident Atrial Fibrillation, and Mortality and Improves Stroke Risk Prediction

Atrial fibrillation (AF) is a major, often undetected, cardiac cause of stroke. Markers of atrial cardiopathy, including left atrial enlargement (LAE) or excessive atrial ectopy (EAE) increase the risk of AF and have shown associations with stroke. We sought to determine whether these markers improve stroke risk prediction beyond traditional vascular risk factors (eg CHA2DS2‐VASc score)..

..Each 10 mm increase in left atrial diameter increased 2‐ and 5‐year adjusted cause‐specific stroke hazard almost 2‐fold (LAE: 2‐year hazard ratio (HR), 1.72; P=0.007; 5‐year HR, 1.87; P<0.0001), while EAE showed no significant associations with stroke (2‐year HR, 1.00; P=0.99; 5‐year HR, 1.08, P=0.70), adjusting for incident AF. Stroke risk estimation improved significantly at 2 (C‐statistics=0.68–0.75, P=0.008) and 5 years (C‐statistics=0.70–0.76, P=0.003) with LAE and EAE.

LAE was independently associated with an increased risk of ischemic stroke in the absence of AF and both LAE and EAE improved stroke risk prediction. These findings have implications for stroke risk stratification, AF screening, and stroke prevention before the onset of AF.