• Jung Myung Lee, Jong Youn Kim, Jaemin Shim, Jae Sun Uhm, Young Jin Kim, Hye-Jeong Lee, Hui-Nam Pak, Moon-Hyoung Lee, and Boyoung Joung.
• Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
• Yonsei Med. J. 2014 Nov 1; 55 (6): 1516-25.

PurposeThe association between pulmonary vein (PV) dilatation and stroke in non-valvular atrial fibrillation (AF) patients remains unknown.Materials And MethodsWe examined the left atrium (LA) and PV in control (n=138) and non-valvular AF patients without (AF group, n=138) and with non-hemorrhagic stroke (AF with stroke group, n=138) using computed tomography.ResultsThe LA, LA appendage (LAA), and all PVs were larger in the AF than control patients. The orifice areas of the LAA (5.6±2.2 cm² vs. 4.7±1.7 cm², p<0.001), left superior PV (3.8±1.5 cm² vs. 3.4±1.2 cm², p=0.019), and inferior PV (2.3±1.0 cm² vs. 1.8±0.7 cm², p<0.001) were larger in the AF with stroke than in the AF only group. However, right PVs were not different between the two groups. In a multivariate analysis, the orifice areas of the left superior PV [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.03-1.51, p=0.02], left inferior PV (OR 1.97, 95% CI 1.41-2.75, p<0.001), and LAA (OR 1.30, 95% CI 1.13-1.50, p<0.001) were independent predictors of stroke.ConclusionCompared to the right PVs, the left PVs and LAA exhibited more significant enlargement in patients with AF and stroke than in patients with AF only. This finding suggests that the remodeling of left-sided LA structures might be related to stroke.

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