Refining cerebrovascular risk in left atrial enlargement: integrating CKM framework and atrial cardiomyopathy phenotyping.

Dong, Weikai; Yang, Guangmin; Wang, Qiang · Eur J Intern Med · 2026

prospective_cohort · Level II

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Abstract

We critically appraise a large prospective cohort study on left atrial enlargement and 1-year cerebrovascular events in patients without atrial fibrillation. While the study provides valuable short-term prognostic evidence, we highlight four key considerations: the overlooked impact of cardiovascular-kidney-metabolic interaction, cautious interpretation of sex-specific findings due to lacking formal interaction tests, potential indication bias in antiplatelet protection claims, and the value of additional atrial cardiomyopathy markers beyond left atrial volume index. Addressing these aspects would enhance risk stratification and translational applicability.