Left Atrial Size

Abstract

Left atrial (LA) enlargement has been proposed as a barometer of diastolic burden and a predictor of common cardiovascular outcomes such as atrial fibrillation, stroke, congestive heart failure, and cardiovascular death. It has been shown that advancing age alone does not independently contribute to LA enlargement, and the impact of gender on LA volume can largely be accounted for by the differences in body surface area between men and women. Therefore, enlargement of the left atrium reflects remodeling associated with pathophysiologic processes. In this review, we discuss the normal size and phasic function of the left atrium. Further, we outline the clinically important aspects and pitfalls of evaluating LA size, and the methods for assessing LA function using echocardiography. Finally, we review the determinants of LA size and remodeling, and we describe the evidence regarding the prognostic value of LA size. The use of LA volume for risk stratification is an evolving science. More data are required with respect to the natural history of LA remodeling in disease, the degree of LA modifiability with therapy, and whether regression of LA size translates into improved cardiovascular outcomes.

Subclinical Cardiac Dysfunction and Brain Health in Midlife: CARDIA (Coronary Artery Risk Development in Young Adults) Brain Magnetic Resonance Imaging Substudy

“…Higher LAV relates to LV filling pressures and is associated with diastolic dysfunction, reflecting long‐term exposure to vascular risk factors, particularly high blood pressure and obesity 19. Enlargement of the left atrium was previously linked to ischemic lesions, loss of brain tissue, and cognitive impairment in older patients 11, 29, 30.…”

“…We studied 3 echocardiographic parameters that represent markers of cardiac dysfunction and predictors of incident heart failure10, 19, 20: LVEF, LAV, and LV mass. LAV was derived from M‐mode left atrial diameter and 2‐dimensional area of the left atrium in the apical 4‐chamber view, using a formula described by Desai 18.…”

Echocardiographic evaluation of diastolic heart failure

“…LA volume has prognostic value for future adverse cardiovascular events including myocardial infarction, cerebrovascular events, atrial fibrillation, HF as well as cardiac and all‐cause mortality 124 , 125 , 126 , 127 . Tsang, et al 118 demonstrated that increasing LA volume stratified risks of developing such adverse events.…”

Left atrial size and risk of recurrent ischemic stroke in a Chinese population

“…As one of the four chambers of the heart, the left atrium plays a major role in cardiac physiology through a variety of mechanical functions to adjust left ventricular (LV) filling and release natriuretic peptides that senses blood volume (Abhayaratna et al., 2006; Leung, Boyd, Ng, Chi, & Thomas, 2008). Left atrial (LA) size increases in response to two main pathophysiologic conditions: pressure and volume overload (Leung et al., 2008).…”