NCT06359873

Left Atrial Enlargement: A Crucial Indicator for Identifying Atrial Fibrillation in Patients With Hypertension

To Investigate the Early Warning Effect of CHA2DS2-VASc Score and Left Atrial Diameter on Atrial Fibrillation in Patients With Hypertension

• Status: Completed
• Phase: —
• Study type: Observational
• Enrollment: 58,427 (actual)
• Sponsor: The Second Affiliated Hospital of Chongqing Medical University · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

Based on the data of inpatients with hypertension and a cross-sectional study with a large sample size, this study aims to find the early warning value of the left anteroposterior atrial diameter for the possible occurrence of atrial fibrillation in patients with hypertension, and compare the advantages and disadvantages of the above two methods for the early warning of the risk of atrial fibrillation in patients with hypertension, so as to achieve the purpose of early identification of high-risk groups that may develop atrial fibrillation.

Detailed description

Background Left atrial enlargement resulting from hypertension is closely linked to the development and persistence of atrial fibrillation (AF). The newly proposed staging recognizes AF as disease continuum, which makes us aware that AF prevention should focus on the Pre-AF stage, and atrial enlargement is one of the important manifestations in this stage. Previous scoring systems, such as CHA2DS2-VASc and C2HEST, along with the recently highlighted left atrial diameter (LAD), have been significant tools for predicting AF occurrence. However, a comprehensive assessment of their utility is currently lacking. Purpose This study aims to explore the role of left atrial size in identifying atrial fibrillation (AF) among hospitalized hypertensives, and to compare its recognition effectiveness with previous scoring systems. Methods The investigators conducted a cross-sectional analysis within hospitalized hypertensives. The discovery, internal and external validation datasets were established. The eXtreme Gradient Boosting (XGBoost) was employed to identify key variables related to AF occurrence, which were ranked based on their importance scores. To gauge the predictive prowess of LAD regarding AF occurrence, the investigators plotted the receiver operating characteristic curve (ROC) and calculated the area under the curve (AUC). This enabled us to pinpoint the LAD cutoff value corresponding to the maximum Youden index, indicative of susceptibility to AF. Subsequently, Youden index determined the optimal cutoff value from the ROC curve. Delong's test compared the identification abilities of different tools within the same dataset. Logistic regression analysis assessed the correlation between clinical variables and left atrial size.

Conditions

• Atrial Fibrillation
• Hypertension,Essential
• Left Atrial Dilatation

Interventions

Type	Name	Description
DIAGNOSTIC_TEST	CHA2DS2-VASc score, C2HEST score, and left atrial diameter (LAD)	CHA2DS2-VASc Score: Congestive heart failure (HF) \[1 point\], hypertension \[1 point\], age ≥ 75 years \[2 points\], diabetes \[1 point\], prior stroke or transient ischemic attack \[2 points\], vascular disease \[1 point\], age 65-74 years \[1 point\], and female gender\[1 point\]. C2HEST Score: Coronary artery disease or chronic obstructive pulmonary disease \[1 point each, 2 total points\]; hypertension \[1 point\]; elderly \[2 points for age ≥ 75 years\]; systolic HF \[2 points\]; and thyroid disease \[1 point for hyperthyroidism\]\[10\]. LAD: The LAD values of the enrolled patients were extracted by keyword search based on the results of echocardiography in the database.

Timeline

• Start date: 2022-05-01
• Primary completion: 2022-09-30
• Completion: 2023-05-01
• First posted: 2024-04-11
• Last updated: 2024-04-11

Locations

1 site across 1 country: China