Association of Left Atrial Size With Stroke or Systemic Embolism in Patients With Atrial Fibrillation Having Undergone Bioprosthetic Valve Replacement From the BPV-AF Registry

• Published in: Circulation Reports Vol. 5; no. 5; pp. 210 - 216
• Main Authors: Tanaka, Hidekazu, Takegami, Misa, Miyake, Makoto, Amano, Masashi, Kitai, Takeshi, Fujita, Tomoyuki, Koyama, Tadaaki, Ando, Kenji, Komiya, Tatsuhiko, Izumo, Masaki, Kawai, Hiroya, Eishi, Kiyoyuki, Yoshida, Kiyoshi, Kimura, Takeshi, Nawada, Ryuzo, Sakamoto, Tomohiro, Shibata, Yoshisato, Fukui, Toshihiro, Minatoya, Kenji, Tsujita, Kenichi, Sakata, Yasushi, Kimura, Tetsuya, Nishimura, Kunihiro, Furukawa, Yutaka, Izumi, Chisato, for the BPV-AF Registry Group
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 10-05-2023
• Subjects: Atrial fibrillation; Bioprosthetic valve replacement; Left atrial volume index; Original article; Thromboembolism; Valvular Heart Disease; Bioprosthetic valve replacement; Thromboembolism; Left atrial volume index; Atrial fibrillation
• ISSN: 2434-0790; 2434-0790
• DOI: 10.1253/circrep.CR-23-0007

Background: The left atrial volume index (LAVI) is important for predicting thromboembolism in patients with non-valvular atrial fibrillation (AF), but the utility of LAVI for predicting thromboembolism in patients with both bioprosthetic valve replacement and AF remains unclear.Methods and Results: Of 894 patients from a previous multicenter prospective observational registry (BPV-AF Registry), 533 whose LAVI data had been obtained by transthoracic echocardiography were included in this subanalysis. Patients were divided into tertiles (T1–T3) according to LAVI as follows: T1 (n=177), LAVI=21.5–55.3 mL/m2; T2 (n=178), LAVI=55.6–82.1 mL/m2; T3 (n=178), LAVI=82.5–408.0 mL/m2. The primary outcome was defined as either stroke or systemic embolism for a mean (±SD) follow-up period of 15.3±4.2 months. Kaplan-Meier curves indicated that the primary outcome tended to occur more frequently in the group with the larger LAVI (log-rank P=0.098). Comparison of T1 with T2 plus T3 using Kaplan-Meier curves indicated that patients in T1 experienced significantly fewer primary outcomes (log-rank P=0.028). Furthermore, univariate Cox proportional hazard regression showed that 1.3- and 3.3-fold more primary outcomes occurred in T2 and T3, respectively, than in T1.Conclusions: Larger LAVI was associated with stroke or systemic embolism in patients who had undergone bioprosthetic valve replacement and with a definitive diagnosis of AF.