Skip to main content
SpringerLink
Log in

Left Atrium

  • Chapter
  • First Online:
Textbook of Three-Dimensional Echocardiography

  • 1240 Accesses

Abstract

The left atrium is a critical cardiac structure. Abnormalities in left atrial function affect not only left ventricular function but also predict poor cardiovascular outcomes. Depending on the population, increased rates of atrial fibrillation, stroke and hospitalization have been associated with increased left atrial size. The left atrium is best assessed with transthoracic echocardiography using dedicated two-dimensional imaging views. While three-dimensional echocardiography-derived volumes are more accurate, current use is limited by lack of normal values and automated analysis packages that allow rapid measurement in clinical practice. Available left atrial cut-offs are based on maximum volumes indexed for body-surface area and do not differ between genders. While much of the available data is on maximum left atrial volume, other measurements may provide more important information on pathological processes and better prognosticate outcomes. These measurements include: changes in left atrial volumes during the cardiac cycle; left atrial contractile function measured through strain; and left atrial shape. Finally, monitoring of left atrial changes and recognition of reverse remodelling may lead to the use of left atrium as therapeutic target in clinical practice and trials.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rosca M, Lancellotti P, Popescu BA, Pierard LA. Left atrial function: pathophysiology, echocardiographic assessment, and clinical applications. Heart. 2011;97:1982–9.

    Article  PubMed  Google Scholar 

  2. Spencer KT, Mor-Avi V, Gorcsan J, et al. Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart. 2001;85:272–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Bouzas-Mosquera A, Broullon FJ, Alvarez-Garcia N, et al. Left atrial size and risk for all-cause mortality and ischemic stroke. CMAJ. 2011;183:E657–64.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kizer JR, Bella JN, Palmieri V, et al. Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: The Strong Heart Study (SHS). Am Heart J. 2006;151(2):412–8.

    Article  PubMed  Google Scholar 

  5. Lancellotti P, Donal E, Magne J, et al. Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay. Heart. 2010;96:1364–71.

    Article  PubMed  Google Scholar 

  6. Le Tourneau T, Messika-Zeitoun D, Russo A, et al. Impact of left atrial volume on clinical outcome in organic mitral regurgitation. J Am Coll Cardiol. 2010;56:570–8.

    Article  PubMed  Google Scholar 

  7. Tsang TSM, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol. 2002;90:1284–9.

    Article  PubMed  Google Scholar 

  8. Tsang TSM, Barnes ME, Gersh BJ, et al. Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography. J Am Coll Cardiol. 2003;42:1199–205.

    Article  PubMed  Google Scholar 

  9. Benjamin EJ, Dagostino RB, Belanger AJ, Wolf PA, Levy D. Left atrial size and the risk of stroke and death—the Framingham Heart-Study. Circulation. 1995;92:835–41.

    Article  CAS  PubMed  Google Scholar 

  10. Tsang TS, Gersh BJ, Appleton CP, et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol. 2002;40:1636–44.

    Article  PubMed  Google Scholar 

  11. Tsang TSM, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Risks for atrial fibrillation and congestive heart failure in patients >= 65 years of age with abnormal left ventricular diastolic relaxation. Am J Cardiol. 2004;93:54–8.

    Article  PubMed  Google Scholar 

  12. Beinart R, Boyko V, Schwammenthal E, et al. Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol. 2004;44:327–34.

    Article  PubMed  Google Scholar 

  13. Moller JE, Hillis GS, Oh JK, et al. Left atrial volume—a powerful predictor of survival after acute myocardial infarction. Circulation. 2003;107:2207–12.

    Article  PubMed  Google Scholar 

  14. Dini FL, Cortigiani L, Baldini U, et al. Prognostic value of left atrial enlargement in patients with idiopathic dilated cardiomyopathy and ischemic cardiomyopathy. Am J Cardiol. 2002;89:518–23.

    Article  PubMed  Google Scholar 

  15. Sabharwal N, Cemin R, Rajan K, Hickman M, Lahiri A, Senior R. Usefulness of left atrial volume as a predictor of mortality in patients with ischemic cardiomyopathy. Am J Cardiol. 2004;94:760–3.

    Article  PubMed  Google Scholar 

  16. Poulsen MK, Dahl JS, Henriksen JE, et al. Left atrial volume index: relation to long-term clinical outcome in type 2 diabetes. J Am Coll Cardiol. 2013;62(25):2416–21.

    Article  PubMed  Google Scholar 

  17. Appleton CP, Galloway JM, Gonzalez MS, Gaballa M, Basnight MA. Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction. J Am Coll Cardiol. 1993;22:1972–82.

    Article  CAS  PubMed  Google Scholar 

  18. Geske JB, Sorajja P, Nishimura RA, Ommen SR. The relationship of left atrial volume and left atrial pressure in patients with hypertrophic cardiomyopathy: an echocardiographic and cardiac catheterization study. J Am Soc Echocardiogr. 2009;22:961–6.

    Article  PubMed  Google Scholar 

  19. Guron CW, Hartford M, Rosengren A, Thelle D, Wallentin I, Caidahl K. Usefulness of atrial size inequality as an indicator of abnormal left ventricular filling. Am J Cardiol. 2005;95:1448–52.

    Article  PubMed  Google Scholar 

  20. Ersboll M, Andersen MJ, Valeur N, Mogensen UM, Waziri H, Moller JE, et al. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size. Circ Cardiovasc Imaging. 2013;6:26–33.

    Article  PubMed  Google Scholar 

  21. Simek CL, Feldman MD, Haber HL, Wu CC, Jayaweera AR, Kaul S. Relationship between left ventricular wall thickness and left atrial size: comparison with other measures of diastolic function. J Am Soc Echocardiogr. 1995;8:37–47.

    Article  CAS  PubMed  Google Scholar 

  22. Badano LP, Miglioranza MH, Mihaila S, et al. Left atrial volumes and function by three-dimensional echocardiography: reference values, accuracy, reproducibility, and comparison with two-dimensional echocardiographic measurements. Circ Cardiovasc Imaging. 2016;9:e004229.

    PubMed  Google Scholar 

  23. Kebed K, Kruse E, Addetia K, et al. Atrial-focused views improve the accuracy of two-dimensional echocardiographic measurements of the left and right atrial volumes: a contribution to the increase in normal values in the guidelines update. Int J Cardiovasc Imaging. 2017;33:209–18.

    Article  PubMed  Google Scholar 

  24. Iwataki M, Takeuchi M, Otani K, et al. Measurement of left atrial volume from transthoracic three-dimensional echocardiographic datasets using the biplane Simpson’s technique. J Am Soc Echocardiogr. 2012;25:1319–26.

    Article  PubMed  Google Scholar 

  25. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–70.

    Article  PubMed  Google Scholar 

  26. Di Tullio MR, Sacco RL, Sciacca RR, Homma S. Left atrial size and the risk of ischemic stroke in an ethnically mixed population. Stroke. 1999;30:2019–24.

    Article  PubMed  Google Scholar 

  27. Olshansky B, Heller EN, Mitchell LB, et al. Are transthoracic echocardlographic parameters associated with atrial fibrillation recurrence or stroke? Results from the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study. J Am Coll Cardiol. 2005;45:2026–33.

    Article  PubMed  Google Scholar 

  28. Rusinaru D, Tribouilloy C, Grigioni F, et al. Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets results from a large international multicenter study. Circ Cardiovasc Imaging. 2011;4:473–U43.

    Article  PubMed  Google Scholar 

  29. Schabelman S, Schiller NB, Silverman NH, Ports TA. Left atrial volume estimation by two-dimensional echocardiography. Catheter Cardio Diag. 1981;7:165–78.

    Article  CAS  Google Scholar 

  30. Wade MR, Chandraratna PAN, Reid CL, Lin SL, Rahimtoola SH. Accuracy of nondirected and directed M-mode echocardiography as an estimate of left atrial size. Am J Cardiol. 1987;60:1208–11.

    Article  CAS  PubMed  Google Scholar 

  31. Vyas H, Jackson K, Chenzbraun A. Switching to volumetric left atrial measurements: impact on routine echocardiographic practice. Eur J Echocardiogr. 2011;12(2):107–11.

    Article  PubMed  Google Scholar 

  32. Badano LP, Pezzutto N, Marinigh R, et al. How many patients would be misclassified using M-mode and two-dimensional estimates of left atrial size instead of left atrial volume? A three-dimensional echocardiographic study. J Cardiovasc Med (Hagerstown). 2008;9:476–84.

    Article  Google Scholar 

  33. Barnes ME, Miyasaka Y, Seward JB, et al. Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation. Mayo Clin Proc. 2004;79:1008–14.

    Article  PubMed  Google Scholar 

  34. Gottdiener JS, Kitzman DW, Aurigemma GP, Arnold AM, Manolio TA. Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons >= 65 years of age (The Cardiovascular Health Study). Am J Cardiol. 2006;97:83–9.

    Article  PubMed  Google Scholar 

  35. Rossi A, Cicoira M, Zanolla L, et al. Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy. J Am Coll Cardiol. 2002;40:1425–30.

    Article  PubMed  Google Scholar 

  36. Takemoto Y, Barnes ME, Seward JB, et al. Usefulness of left atrial volume in predicting first congestive heart failure in patients >= 65 years of age with well-preserved left ventricular systolic function. Am J Cardiol. 2005;96:832–6.

    Article  PubMed  Google Scholar 

  37. Tsang TSM, Abhayaratna WP, Barnes ME, et al. Prediction of cardiovascular outcomes with left atrial size—is volume superior to area or diameter? J Am Coll Cardiol. 2006;47:1018–23.

    Article  PubMed  Google Scholar 

  38. Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM. Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol. 2003;41:1036–43.

    Article  PubMed  Google Scholar 

  39. Russo C, Hahn RT, Jin ZZ, Homma S, Sacco RL, Di Tullio MR. Comparison of echocardiographic single-plane versus biplane method in the assessment of left atrial volume and validation by real time three-dimensional echocardiography. J Am Soc Echocardiogr. 2010;23:954–60.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Nistri S, Galderisi M, Ballo P, et al. Determinants of echocardiographic left atrial volume: implications for normalcy. Eur J Echocardiogr. 2011;12:826–33.

    Article  PubMed  Google Scholar 

  41. Kou S, Caballero L, Dulgheru R, et al. Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE Study. Eur Heart J Cardiovasc Imaging. 2014;15(6):680–90.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Surkova E, Badano LP, Genovese D, et al. Clinical and prognostic implications of methods and partition values used to assess left atrial volume by two-dimensional echocardiography. J Am Soc Echocardiogr. 2017;30:1119–29.

    Article  PubMed  Google Scholar 

  43. Mor-Avi V, Yodwut C, Jenkins C, et al. Real-time 3D echocardiographic quantification of left atrial volume: multicenter study for validation with CMR. JACC Cardiovasc Imaging. 2012;5:769–77.

    Article  PubMed  Google Scholar 

  44. Aune E, Baekkevar M, Roislien J, Rodevand O, Otterstad JE. Normal reference ranges for left and right atrial volume indexes and ejection fractions obtained with real-time three-dimensional echocardiography. Eur J Echocardiogr. 2009;10:738–44.

    Article  PubMed  Google Scholar 

  45. Azar F, Perez de Isla L, Moreno M, et al. Three-dimensional echocardiographic assessment of left atrial size and function and the normal range of asynchrony in healthy individuals. Rev Esp Cardiol. 2009;62:816–9.

    Article  PubMed  Google Scholar 

  46. Sugimoto T, Robinet S, Dulgheru R, et al. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2018;19:630–8.

    Article  PubMed  Google Scholar 

  47. Tsang W, Salgo IS, Medvedofsky D, et al. Transthoracic 3D echocardiographic left heart chamber quantification using an automated adaptive analytics algorithm. JACC Cardiovasc Imaging. 2016;9:769–82.

    Article  PubMed  Google Scholar 

  48. Wu VC, Takeuchi M, Kuwaki H, et al. Prognostic value of LA volumes assessed by transthoracic 3D echocardiography: comparison with 2D echocardiography. JACC Cardiovasc Imaging. 2013;6:1025–35.

    Article  PubMed  Google Scholar 

  49. Suh IW, Song JM, Lee EY, et al. Left atrial volume measured by real-time 3-dimensional echocardiography predicts clinical outcomes in patients with severe left ventricular dysfunction and in sinus rhythm. J Am Soc Echocardiogr. 2008;21:439–45.

    Article  PubMed  Google Scholar 

  50. Russo C, Jin Z, Homma S, et al. LA phasic volumes and reservoir function in the elderly by real-time 3D echocardiography: normal values, prognostic significance, and clinical correlates. JACC Cardiovasc Imaging. 2017;10:976–85.

    Article  PubMed  Google Scholar 

  51. Rodevand O, Bjornerheim R, Ljosland M, Maehle J, Smith HJ, Ihlen H. Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Cardiac Imag. 1999;15:397–410.

    Article  Google Scholar 

  52. Stojanovska J, Cronin P, Patel S, et al. Reference normal absolute and indexed values from ecg-gated MDCT: left atrial volume, function, and diameter. Am J Roentgenol. 2011;197:631–7.

    Article  Google Scholar 

  53. Vasan RS, Levy D, Larson MG, Benjamin EJ. Interpretation of echocardiographic measurements: a call for standardization. Am Heart J. 2000;139:412–22.

    Article  CAS  PubMed  Google Scholar 

  54. Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107–33.

    Article  PubMed  Google Scholar 

  55. Abhayaratna WP, Seward JB, Appleton CP, et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol. 2006;47:2357–63.

    Article  PubMed  Google Scholar 

  56. Welles CC, Ku IA, Kwan DM, Whooley MA, Schiller NB, Turakhia MP. Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study. J Am Coll Cardiol. 2012;59:673–80.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Mehta S, Charbonneau F, Fitchett DH, Marpole DG, Patton R, Sniderman AD. The clinical consequences of a stiff left atrium. Am Heart J. 1991;122:1184–91.

    Article  CAS  PubMed  Google Scholar 

  58. Thamilarasan M, Klein AL. Factors relating to left atrial enlargement in atrial fibrillation: “chicken or the egg” hypothesis. Am Heart J. 1999;137:381–3.

    Article  CAS  PubMed  Google Scholar 

  59. Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54:230–46.

    Article  CAS  PubMed  Google Scholar 

  60. Schoonderwoerd BA, Ausma J, Crijns HJ, Van Veldhuisen DJ, Blaauw EH, Van Gelder IC. Atrial ultrastructural changes during experimental atrial tachycardia depend on high ventricular rate. J Cardiovasc Electrophysiol. 2004;15:1167–74.

    Article  PubMed  Google Scholar 

  61. Tsang TS, Barnes ME, Abhayaratna WP, et al. Effects of quinapril on left atrial structural remodeling and arterial stiffness. Am J Cardiol. 2006;97:916–20.

    Article  CAS  PubMed  Google Scholar 

  62. Gerdts E, Wachtell K, Omvik P, et al. Left atrial size and risk of major cardiovascular events during antihypertensive treatment: losartan intervention for endpoint reduction in hypertension trial. Hypertension. 2007;49:311–6.

    Article  CAS  PubMed  Google Scholar 

  63. Nunes MC, Handschumacher MD, Levine RA, et al. Role of LA shape in predicting embolic cerebrovascular events in mitral stenosis: mechanistic insights from 3D echocardiography. JACC Cardiovasc Imaging. 2014;7:453–61.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994;89:724–30.

    Article  CAS  PubMed  Google Scholar 

  65. Tsang TS, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol. 2006;47:1018–23.

    Article  PubMed  Google Scholar 

  66. Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP. Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction. J Am Coll Cardiol. 2019;73 (15):1961–77.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

    Wendy Tsang

  2. Department of Medicine/Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA

    Kirk T. Spencer

  3. Noninvasive Cardiac Imaging Laboratories, Department of Medicine/Section of Cardiology, University of Chicago Medical Center, Chicago, IL, USA

    Roberto M. Lang

Authors
  1. Wendy Tsang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kirk T. Spencer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto M. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wendy Tsang .

Editor information

Editors and Affiliations

  1. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy

    Luigi P. Badano

  2. Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA

    Roberto M. Lang

  3. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy

    Denisa Muraru

Electronic Supplementary Material

Dynamic surface rendering of left atrial volume (AVI 3877 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tsang, W., Spencer, K.T., Lang, R.M. (2019). Left Atrium. In: Badano, L., Lang, R., Muraru, D. (eds) Textbook of Three-Dimensional Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-030-14032-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-14032-8_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-14030-4

  • Online ISBN: 978-3-030-14032-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation