Abstract

We aimed to identify the predictors of left atrial (LA) enlargement by multi-detector computed tomography (CT) and determine its association and predictive value for acute coronary syndrome (ACS).LA enlargement is associated with myocardial ischemia and coronary artery disease (CAD) and is a strong predictor for cardiovascular events. These studies were performed primarily with echocardiography. With the rise of cardiac CT, LA volume can be readily measured.In 377 emergency department patients with chest pain, we performed 64-slice CT for coronary artery assessment. We derived LA volumes (LAV(max), LAV(min)) and indices (LAVI(max), LAVI(min)) using a threshold-based volumetric method.Subjects, with cardiac risk factors or CAD by CT, had larger LA (?LAV(max) 9.1 ml, p=0.004; ?LAV(min) 8.1 ml, p=0.001; ?LAVI(max) 3.3 ml/m(2), p=0.03; ?LAVI(min) 3.4 ml/m(2), p=0.006) than controls. Predictors of LA enlargement were related to risk factors for diastolic dysfunction. ACS risk was greater in patients with top quartile LAV(max) (odds ratio [OR] 3.4, p=0.02) and LAV(min) (OR 4.7, p=0.01) than lowest quartile, but not when indexed. Similarly, the predictive values of LA volumes were incrementally better when added to CT finding of indeterminate stenosis (LAV(max): C statistic 0.62 to 0.70, p=0.046; LAV(min): C statistic 0.65 to 0.73, p=0.008), but not when indexed.Risk factors related to diastolic dysfunction are independent predictors of LA enlargement. LA enlargement by volumes are associated with a 3-5 fold increase risk for ACS and have incremental value for predicting ACS when added to the CT finding of indeterminate stenosis.

View details for DOI 10.1016/j.ijcard.2009.06.029

View details for Web of Science ID 000286184400014

View details for PubMedID 19615769