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

Table 1 Baseline clinical and echocardiographic characteristics

Clinical		Echocardiographic
Age (yr)	57 ± 12	Ejection fraction (%)	59 ± 10
Male	32%	Reduced EF	11%
Tobacco	60%	LA Diam (cm)	3.7 ± 0.6
Family history of CAD	34%	LA Diam index (cm/m2)	1.9 ± 0.4
Hyperlipidemia	50%	Abn LA Diam index	9%
Diabetes mellitus	38%	LV mass (g)	172 ± 59
Obesity	45%	LV mass index (g/m2)	89 ± 29
CAD	19%	LV hypertrophy	25%
Heart failure	11%	Relative wall thickness	0.51
Atrial fibrillation	3%	LV remodeling pattern
CKD (GFR < 60)	17%	Normal geometry	22%
Systolic BP (mmHg)	140 ± 17	Concentric remodeling	52%
Hypertensive therapy	90%	Concentric hypertrophy	21%
Diuretic	56%	Eccentric hypertrophy	4%
Calcium channel blocker	33%	Dobutamine study	40%
ACE-I/ARB	55%	Abnormal stress echo	17%
Beta-blocker	46%

Data are presented as the mean value + standard deviation or percent baseline prevalence. CAD: Coronary artery disease; CKD: Chronic kidney disease; GFR: Glomerular filtration rate; BP: Blood pressure; ACE-I: Angiotensin converting enzyme inhibitor; ARB: Angiotensin II receptor blocker; EF: Ejection fraction; LA: Left atrial; LV: Left ventricular.

Table 2 Univariate predictors of all-cause mortality

Characteristic	Event	No event	Hazard ratio (95%CI)	P value
Clinical
Age	62.9	56.5	1.04 (1.02-1.06)	< 0.001
Male sex	40%	32%	1.43 (0.92-2.20]	0.109
Tobacco	79%	57%	2.55 (1.51-4.29)	< 0.001
Fam. History of CAD	28%	35%	0.73 (0.45-1.28)	0.194
Hyperlipidemia	48%	51%	0.91 (0.59-1.40)	0.662
Diabetes mellitus	52%	36%	1.77 (1.16-2.71)	0.008
Obesity	32%	47%	0.56 (0.35-0.88)	0.010
CAD	33%	17%	2.15 (1.37-3.38)	0.001
Heart failure	27%	9%	3.44 (2.13-5.56)	< 0.001
Atrial fibrillation	7%	2%	2.70 (1.18-6.19)	0.019
CKD (GFR < 60)	29%	15%	2.37 (1.48-3.78)	< 0.001
Systolic BP (mmHg)	141.5	140.0	1.01 (0.999-1.02)	0.438
Echocardiographic
Reduced EF	25%	9%	2.89 (1.76-4.72)	< 0.001
Abn. LA index (2.40 cut-point)	24%	7%	3.16 (1.91-5.22)	< 0.001
Abn. LA index (2.05 cut-point)	61%	28%	3.35 (2.17-5.18)	< 0.001
LV hypertrophy	52%	21%	3.62 (2.36-5.54)	< 0.001
Relative wall thickness	0.51	0.51	0.94 (0.19-4.57)	0.941
LV diastolic diameter	4.54	4.34	1.57 (1.15-2.13)	0.005
LV systolic diameter	3.24	2.98	1.54 (1.20-1.99)	0.001
Fractional shortening	0.30	0.32	0.05 (0.00-0.57)	0.017
IV septum thickness	1.20	1.11	2.51 (1.19-5.33)	0.016
LV post. wall thickness	1.13	1.07	2.48 (1.04-5.92)	0.040
Dobutamine study	68%	35%	3.55 (2.25-5.60)	< 0.001
Abnormal stress	35%	14%	2.76 (1.77-4.31)	< 0.001

CAD: Coronary artery disease; CKD: Chronic kidney disease; GFR: Glomerular filtration rate; BP: Blood pressure; EF: Ejection fraction; Abn. LA index: Abnormal left atrial diameter indexed to body surface area (cm/m²); LV: Left ventricular; IV: Intraventricular; Post.: Posterior; See text for further explanation of variables.

Table 3 Multivariate predictors of all-cause mortality

	Reference cut-point for Abn. LA Diam			Best cut-point for Abn. LA Diam
	Chi-square 102			Chi-square 107
Predictor	Wald	HR (95%CI)	P value	Wald	HR (95%CI)	P value
Age (per 10 yr)	11.4	1.40 (1.15-1.71)	0.001	8.2	1.34 (1.10-1.64)	0.004
Tobacco	11.9	2.61 (1.51-4.49)	0.001	11.9	2.59 (1.51-4.44)	0.001
Heart failure	6.4	1.92 (1.16-3.20)	0.012	4.7	1.76 (1.05-2.94)	0.031
LVH	17.6	2.54 (1.64-3.93)	<0.001	10.5	2.14 (1.35-3.39)	0.001
Abnormal stress	5.9	1.79 (1.12-2.86)	0.015	4.6	1.67 (1.04-2.68)	0.033
Dobutamine study	8.5	2.09 (1.27-3.43)	0.004	8.9	2.12 (1.29-3.47)	0.003
LA index ≥ 2.40	–	–	NS	1	1	1
LA index ≥ 2.05	1	1	1	4.9	1.73 (1.06-2.82)	0.027

¹Variable not included in calculation.

Column (Reference cut-point for Abn. LA Diam) demonstrated a multivariate analysis using the reference cut-point of 2.40 cm/m² for defining an abnormal left atrium and column (Best cut-point for Abn. LA Diam) demonstrates a multivariate analysis using the best cut-point of 2.05 cm/m². ABN: Abnormal; DIAM: Diameter, LVH: Left ventricular hypertrophy; LA index: Left atrium diameter index (cm/m²).