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Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography

BACKGROUND: Left atrial (LA) enlargement is a marker of increased risk in the general population undergoing stress echocardiography. African American (AA) patients with hypertension are known to have less atrial remodeling than whites with hypertension. The prognostic impact of LA enlargement in AA...

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Autores principales: Khemka, Abhishek, Sutter, David A, Habhab, Mazin N, Thomaides, Athanasios, Hornsby, Kyle, Feigenbaum, Harvey, Sawada, Stephen G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716971/
https://www.ncbi.nlm.nih.gov/pubmed/35070115
http://dx.doi.org/10.4330/wjc.v13.i12.733
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author Khemka, Abhishek
Sutter, David A
Habhab, Mazin N
Thomaides, Athanasios
Hornsby, Kyle
Feigenbaum, Harvey
Sawada, Stephen G
author_facet Khemka, Abhishek
Sutter, David A
Habhab, Mazin N
Thomaides, Athanasios
Hornsby, Kyle
Feigenbaum, Harvey
Sawada, Stephen G
author_sort Khemka, Abhishek
collection PubMed
description BACKGROUND: Left atrial (LA) enlargement is a marker of increased risk in the general population undergoing stress echocardiography. African American (AA) patients with hypertension are known to have less atrial remodeling than whites with hypertension. The prognostic impact of LA enlargement in AA with hypertension undergoing stress echocardiography is uncertain. AIM: To investigate the prognostic value of LA size in hypertensive AA patients undergoing stress echocardiography. METHODS: This retrospective outcomes study enrolled 583 consecutive hypertensive AA patients who underwent stress echocardiography over a 2.5-year period. Clinical characteristics including cardiovascular risk factors, stress and echocardiographic data were collected from the electronic health record of a large community hospital. Treadmill exercise and Dobutamine protocols were conducted based on standard practices. Patients were followed for all-cause mortality. The optimal cutoff value of antero-posterior LA diameter for mortality was assessed by receiver operating characteristic analysis. Cox regression was used to determine variables associated with outcome. RESULTS: The mean age was 57 ± 12 years. LA dilatation was present in 9% (54) of patients (LA anteroposterior ≥ 2.4 cm/m(2)). There were 85 deaths (15%) during 4.5 ± 1.7 years of follow-up. LA diameter indexed for body surface area had an area under the curve of 0.72 ± 0.03 (optimal cut-point of 2.05 cm/m(2)). Variables independently associated with mortality included age [P = 0.004, hazard ratio (HR) 1.34 (1.10-1.64)], tobacco use [P = 0.001, HR 2.59 (1.51-4.44)], left ventricular hypertrophy [P = 0.001 , HR 2.14 (1.35-3.39)], Dobutamine stress [P = 0.003, HR 2.12 (1.29-3.47)], heart failure history [P = 0.031, HR 1.76 (1.05-2.94)], LA diameter ≥ 2.05 cm/m(2 )[P = 0.027, HR 1.73 (1.06-2.82)], and an abnormal stress echocardiogram [P = 0.033, HR 1.67 (1.04-2.68)]. LA diameter as a continuous variable was also independently associated with mortality but LA size ≥ 2.40 cm/m(2 )was not. CONCLUSION: LA enlargement is infrequent in hypertensive AA patients when traditional reference values are used. LA enlargement is independently associated with mortality when a lower than “normal” threshold (≥ 2.05 cm/m(2)) is used.
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spelling pubmed-87169712022-01-20 Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography Khemka, Abhishek Sutter, David A Habhab, Mazin N Thomaides, Athanasios Hornsby, Kyle Feigenbaum, Harvey Sawada, Stephen G World J Cardiol Retrospective Study BACKGROUND: Left atrial (LA) enlargement is a marker of increased risk in the general population undergoing stress echocardiography. African American (AA) patients with hypertension are known to have less atrial remodeling than whites with hypertension. The prognostic impact of LA enlargement in AA with hypertension undergoing stress echocardiography is uncertain. AIM: To investigate the prognostic value of LA size in hypertensive AA patients undergoing stress echocardiography. METHODS: This retrospective outcomes study enrolled 583 consecutive hypertensive AA patients who underwent stress echocardiography over a 2.5-year period. Clinical characteristics including cardiovascular risk factors, stress and echocardiographic data were collected from the electronic health record of a large community hospital. Treadmill exercise and Dobutamine protocols were conducted based on standard practices. Patients were followed for all-cause mortality. The optimal cutoff value of antero-posterior LA diameter for mortality was assessed by receiver operating characteristic analysis. Cox regression was used to determine variables associated with outcome. RESULTS: The mean age was 57 ± 12 years. LA dilatation was present in 9% (54) of patients (LA anteroposterior ≥ 2.4 cm/m(2)). There were 85 deaths (15%) during 4.5 ± 1.7 years of follow-up. LA diameter indexed for body surface area had an area under the curve of 0.72 ± 0.03 (optimal cut-point of 2.05 cm/m(2)). Variables independently associated with mortality included age [P = 0.004, hazard ratio (HR) 1.34 (1.10-1.64)], tobacco use [P = 0.001, HR 2.59 (1.51-4.44)], left ventricular hypertrophy [P = 0.001 , HR 2.14 (1.35-3.39)], Dobutamine stress [P = 0.003, HR 2.12 (1.29-3.47)], heart failure history [P = 0.031, HR 1.76 (1.05-2.94)], LA diameter ≥ 2.05 cm/m(2 )[P = 0.027, HR 1.73 (1.06-2.82)], and an abnormal stress echocardiogram [P = 0.033, HR 1.67 (1.04-2.68)]. LA diameter as a continuous variable was also independently associated with mortality but LA size ≥ 2.40 cm/m(2 )was not. CONCLUSION: LA enlargement is infrequent in hypertensive AA patients when traditional reference values are used. LA enlargement is independently associated with mortality when a lower than “normal” threshold (≥ 2.05 cm/m(2)) is used. Baishideng Publishing Group Inc 2021-12-26 2021-12-26 /pmc/articles/PMC8716971/ /pubmed/35070115 http://dx.doi.org/10.4330/wjc.v13.i12.733 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Retrospective Study
Khemka, Abhishek
Sutter, David A
Habhab, Mazin N
Thomaides, Athanasios
Hornsby, Kyle
Feigenbaum, Harvey
Sawada, Stephen G
Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography
title Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography
title_full Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography
title_fullStr Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography
title_full_unstemmed Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography
title_short Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography
title_sort prognostic value of left atrial size in hypertensive african americans undergoing stress echocardiography
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716971/
https://www.ncbi.nlm.nih.gov/pubmed/35070115
http://dx.doi.org/10.4330/wjc.v13.i12.733
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