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Background Atrial fibrillation (AF) is a major, often undetected, cardiac cause of stroke. Markers of atrial cardiopathy, including left atrial enlargement (LAE) or excessive atrial ectopy (EAE) increase the risk of AF and have shown associations with stroke. We sought to determine whether these markers improve stroke risk prediction beyond traditional vascular risk factors (eg CHA2DS2‐VASc score). Methods and Results Retrospective longitudinal cohort of 32 454 consecutive community‐dwelling adults aged ≥65 years referred for outpatient echocardiogram or Holter in Ontario, Canada (2010–2017). Moderate‐severe LAE was defined as men >47 mm and women >43 mm, and EAE was defined as >30 APBs per hour. Cause‐specific competing risks Cox proportional hazards used to estimate risk of ischemic stroke (primary), incident AF, and death (secondary). C‐statistics, incremental discrimination improvement and net reclassification were used to compare CHA2DS2‐VASc with LAE and EAE to CHA2DS2‐VASc alone. Each 10 mm increase in left atrial diameter increased 2‐ and 5‐year adjusted cause‐specific stroke hazard almost 2‐fold (LAE: 2‐year hazard ratio (HR), 1.72; P=0.007; 5‐year HR, 1.87; P |
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