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September 3, 2026International Journal of General MedicineOpen Access

Development and Internal Validation of a Diagnostic Nomogram for Identifying Left Atrial Enlargement in Patients with Essential Hypertension

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Population

251 adults with a confirmed diagnosis of essential hypertension admitted to a single center in China…

Design

Cross-sectional

Key result

A diagnostic nomogram incorporating five clinical variables demonstrated high internal discrimination for identifying left atrial enlargement in essential hypertension, with an AUC of 0.937.

Authors

WWWei WenYHYanyu HuangJRJiahuan Rao

Discussion

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Overview

May aid preliminary risk stratification in hypertension; leaves open external validation before clinical use.

Key Points

  • To develop and internally validate an accessible diagnostic nomogram using standard clinical metrics to estimate the probability of left atrial enlargement in patients with essential hypertension.
  • Retrospectively analyzed clinical and echocardiographic data from 251 patients with essential hypertension admitted between August 2023 and September 2024 using a cross-sectional design.
  • Entered five prespecified variables (age, hypertension duration, atrial fibrillation, hypertension stage, and coronary heart disease) into a multivariable logistic regression model to construct the nomogram.
  • Older age (OR = 1.15, 95% CI: 1.08–1.24, p < 0.001), longer hypertension duration (OR = 2.00, 95% CI: 1.25–3.57, p = 0.003), and atrial fibrillation (OR = 3.70, 95% CI: 1.15–12.12, p = 0.028) were independent predictors of left atrial enlargement.
  • The diagnostic nomogram achieved high discriminative performance with an apparent AUC of 0.937, an optimism-corrected AUC of 0.920 after 1,000 bootstrap resamples, and a mean absolute calibration error of 0.017.

Study Design

Type

Cross-Sectional (n=251)

Multicenter

No

Structured PICO

P
Population
251 adult patients with essential hypertension were retrospectively evaluated to develop and internally validate a diagnostic nomogram for identifying left atrial enlargement.
E
Exposure
Diagnostic nomogram incorporating 5 clinical variables (age, hypertension duration, atrial fibrillation, hypertension stage, and coronary heart disease) to estimate the probability of left atrial enlargement.
O
Outcome
Presence of left atrial enlargement (LAE), defined as a left atrial anteroposterior diameter >40 mm in men and >38 mm in women.surrogate

Main Result

Effect estimate: AUC 0.937 (95% CI 0.899-0.975)

A novel 5-variable clinical nomogram demonstrated high internal discrimination for identifying left atrial enlargement in patients with essential hypertension, offering a simple tool for early risk stratification.

Limitations

  • Retrospective, single-center design with a relatively small sample size and low event count (26 LAE cases).
  • Lack of external validation in larger, independent, multicenter populations.
  • LAE definition was based on left atrial anteroposterior diameter rather than the guideline-recommended volumetric measure (LAVI).
  • Echocardiographic parameters such as LVDD and LVH were not included as candidate predictors.
  • Retrospective, single-center design with a relatively small sample size (n=251) and low event count (26 LAE cases), increasing the risk of selection bias and model overfitting.
  • Use of left atrial anteroposterior diameter rather than the current guideline-recommended volumetric measure (LAVI) due to historical data availability.

Cite This Study

Wen et al. (2026) conducted a cross-sectional in Essential hypertension (n=251). Clinical predictors (age, hypertension duration, atrial fibrillation, hypertension stage, coronary heart disease) was evaluated on Discriminative performance of the nomogram for identifying left atrial enlargement (AUC 0.937, 95% CI 0.899-0.975). A diagnostic nomogram incorporating five clinical variables demonstrated high internal discrimination for identifying left atrial enlargement in essential hypertension, with an AUC of 0.937.

synapsesocial.com/papers/6a9935d8636c6408cfa7e619https://doi.org/10.2147/ijgm.s619567
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