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Assessment of left atrial volume: a focus on echocardiographic methods and clinical implications

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Abstract

Left atrial enlargement is an important predictor of cardiovascular events such as atrial fibrillation, stroke, heart failure and mortality. A number of methods of left atrial size assessment by echocardiography have been reported, from the simple antero-posterior diameter in the parasternal long axis view to the more complex ellipsoid, area-length and Simpson’s method of estimating left atrial volume. These different methods of left atrial size assessment, their clinical implications and some common pitfalls are discussed in this review.

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References

  1. Spencer KT, Mor-Avi V, Gorcsan J 3rd, Demaria AN, Kimball TR, Monaghan MJ, Perez JE, Weinert L, Bednarz J, Edelman K, Kwan OL, Glascock B, Hancock J, Baumann C, Lang RM (2001) Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart 85:272–277

    Article  CAS  PubMed  Google Scholar 

  2. Plaschkes J, Borman J, Merin G, Milwidsky H (1971) Giant left atrium in rheumatic heart disease: a report of 18 cases treated by mitral valve replacement. Ann Surg 174:194–201

    Article  CAS  PubMed  Google Scholar 

  3. Takemoto Y, Barnes ME, Seward JB, Lester SJ, Appleton CA, Gersh BJ, Bailey KR, Tsang TS (2005) Usefulness of left atrial volume in predicting first congestive heart failure in patients > or = 65 years of age with well-preserved left ventricular systolic function. Am J Cardiol 96:832–836

    Article  PubMed  Google Scholar 

  4. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, Tsang TSM (2006) Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 47:2357–2363

    Article  PubMed  Google Scholar 

  5. Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB (2002) Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol 90:1284–1289

    Article  PubMed  Google Scholar 

  6. Tsang TS, Barnes ME, Gersh BJ, Takemoto Y, Rosales AG, Bailey KR, Seward JB (2003) Prediction of risk for age-related cardiovascular events in an elderly population: the incremental value of echocardiography. J Am Coll Cardiol 42:1199–1205

    Article  PubMed  Google Scholar 

  7. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward JB, Shanewise J, Solomon S, Spencer KT, Sutton MST, Stewart W (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification writing group, developed in conjunction with European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  8. Lemire F, Tajik AJ, Hagler DJ (1976) Asymmetric left atrial enlargement; an echocardiographic observation. Chest 69:779–781

    Article  CAS  PubMed  Google Scholar 

  9. Lester SJ, Ryan EW, Schiller NB, Foster E (1999) Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol 84:829–832

    Article  CAS  PubMed  Google Scholar 

  10. Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM (2003) Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol 41:1036–1043

    Article  PubMed  Google Scholar 

  11. Tsang TS, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, Cha SS, Seward JB (2006) Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol 47:1018–1023

    Article  PubMed  Google Scholar 

  12. Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, White R, Furberg CD, Rautaharju PM (1997) Incidence of and risk factors for atrial fibrillation in older adults. Circulation 96:2455–2461

    CAS  PubMed  Google Scholar 

  13. Vaziri SM, Larson MG, Benjamin EJ, Levy D (1994) Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation 89:724–730

    CAS  PubMed  Google Scholar 

  14. Dittrich HC, Pearce LA, Asinger RW, McBride R, Webel R, Zabalgoitia M, Pennock GD, Safford RE, Rothbart RM, Halperin JL, Hart R (1999) Left atrial diameter in nonvalvular atrial fibrillation: an echocardiographic study Stroke Prevention in Atrial Fibrillation Investigators. Am Heart J 137:494–499

    Article  CAS  PubMed  Google Scholar 

  15. Sanfilippo AJ, Abascal VM, Sheehan M, Oertel LB, Harrigan P, Hughes RA, Weyman AE (1990) Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation 82:792–797

    CAS  PubMed  Google Scholar 

  16. Osranek M, Bursi F, Bailey KR, Grossardt BR, Brown RD Jr, Kopecky SL, Tsang TS, Seward JB (2005) Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up. Eur Heart J 26:2556–2561

    Article  PubMed  Google Scholar 

  17. Caplan LR, D’Cruz I, Hier DB, Reddy H, Shah S (1986) Atrial size, atrial fibrillation and stroke. Ann Neurol 19:158–161

    Article  CAS  PubMed  Google Scholar 

  18. Di Tullio MR, Sacco RL, Sciacca RR, Homma S (1999) Left atrial size and the risk of ischemic stroke in an ethnically mixed population. Stroke 30:24–2091

    Google Scholar 

  19. Benjamin EJ, D’Agostino RB, Belanger AJ, Wolf PA, Levy D (1995) Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 92:835–841

    CAS  PubMed  Google Scholar 

  20. Gardin JM, McClelland R, Kitzman D, Lima JA, Bommer W, Klopfenstein HS, Wong ND, Smith VE, Gottdiener J (2001) M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study). Am J Cardiol 87:1051–1057

    Article  CAS  PubMed  Google Scholar 

  21. Laukkanen JA, Kurl S, Eranen J, Huttunen M, Salonen JT (2005) Left atrium size and the risk of cardiovascular death in middle-aged men. Arch Intern Med 165:1788–1793

    Article  PubMed  Google Scholar 

  22. Khankirawatana B, Khankirawatana S, Porter T (2004) How should left atrial size be reported? Comparative assessment with use of multiple echocardiographic methods. Am Heart J 147:369–374

    Article  PubMed  Google Scholar 

  23. Teo SG, Yang H, Chai P, Yeo TC (2010) Impact of left ventricular diastolic dysfunction on left atrial volume and function: a volumetric analysis. Eur J Echocardiogr 11:38–43

    Article  PubMed  Google Scholar 

  24. Milan A, Caserta MA, Dematteis A, Naso D, Pertusio A, Magnino C, Puglisi E, Rabbia F, Pandian NG, Mulatero P, Veglio F (2009) Blood pressure levels, left ventricular mass and cunfion are correlated with left atrial volume in mild to moderate hypertensive patients. J Hum Hypertens 23:743–750

    Article  CAS  PubMed  Google Scholar 

  25. Sura D, Marin F, Climent V, Gonzalez J, Roldan V, Hernandez-Romero D, Oliva MJ, Sabater M, de la Morena G, Lip GY, Valdes M (2009) Left atrial remodelling in hypertrophic cardiomyopathy: relation with exercise capacity and biochemical markers of tissue strain and remodelling. Int J Clin Pract 63:1456–1471

    Article  Google Scholar 

  26. Wong RC, Yeo TC (2009) Left atrial volume is an independent predictor of exercise capacity in patients with isolated left ventricular diastolic dysfunction. Int J Cardiol [Epub ahead of print]

  27. Cho DK, Ha JW, Chang BC, Lee SH, Yoon SJ, Shim CY, Cho JR, Kim JS, Choi EY, Rim SJ, Chung N (2008) Factors determining early left atrial reverse remodelling after mitral valve surgery. Am J Cardiol 101:374–377

    Article  PubMed  Google Scholar 

  28. Gottdiener JS, Kitzman DW, Aurigemma GP, Arnold AM, Manolio TA (2006) Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons < or = 65 years of age (the cardiovascular health study). Am J Cardiol 97:83–89

    Article  PubMed  Google Scholar 

  29. Sabharwal N, Cemin R, Rajan K, Hickman M, Lahiri A, Senior R (2004) Usefulness of left atrial volume as a predictor of mortality in patients with ischemic cardiomyopathy. Am J Cardiol 94:760–763

    Article  PubMed  Google Scholar 

  30. Welikovitch L, Lafreniere G, Burggraf GW, Sanfillippo AJ (1994) Change in atrial volume following restoration of sinus rhythm in patients with atrial fibrillation: a prospective echocardiographic study. Can J Cardiol 10:993–996

    CAS  PubMed  Google Scholar 

  31. Lim TK, Dwivedi G, Hayat S, Majumdar S, Senior R (2009) Independent value of left atrial volume index for the prediction of mortality in patients with suspected heart failure referred from the community. Heart 95:1172–1178

    Article  CAS  PubMed  Google Scholar 

  32. Tsang TS, Barnes ME, Bailey KR, Leibson CL, Montgomery SC, Takemoto Y, Diamond PM, Marra MA, Gersh BJ, Wiebers DO, Petty GW, Seward JB (2001) Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc 76:467–475

    Article  CAS  PubMed  Google Scholar 

  33. Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward KB (2004) Risks for atrial fibrillation and congestive heart failure in patients ≥65 years of age with abnormal left ventricular diastolic relaxation. Am J Cardiol 93:54–58

    Article  PubMed  Google Scholar 

  34. Casaclang-Verzosa G, Barnes ME, Blume G, Seward JB, Gersh BJ, Cha SS, Bailey KR, Tsang TS (2010) C-reactive protein, left atrial volume, and atrial fibrillation: a prospective study in high-risk elderly. Echocardiography 27:394–399

    Article  PubMed  Google Scholar 

  35. Fatema K, Barnes ME, Bailey KR, Abhayaratna WP, Cha S, Seward JB, Tsang TS (2009) Minimum vs maximum left atrial volume for prediction of first atrial fibrillation or flutter in an elderly cohort: a prospective study. Eur J Echocardiogr 10:282–286

    Article  PubMed  Google Scholar 

  36. Fatema K, Bailey KR, Petty GW, Meissner I, Osranek M, Alsaileek AA, Khandheria BK, Tsang TS, Seward JB (2008) Increased left atrial volume index: potent biomarker for first-ever ischemic stroke. Mayo Clin Proc 83:1107–1115

    Article  PubMed  Google Scholar 

  37. Triposkiadis F, Harbas C, Kelepeshis G, Sitafidis G, Skoularigis J, Demopoulos V, Tsilimingas N (2007) Left atrial remodelling in patients younger than 70 years with diastolic and systolic heart failure. J Am Soc Echocardiogr 20:177–185

    Article  PubMed  Google Scholar 

  38. Tanabe K, Yamaguchi K, Tani T, Yagi T, Katayama M, Tamita K, Kinoshita M, Kaji S, Yamamuro A, Morioka S, Okada Y, Kihara Y (2007) Left atrial volume: predictor of atrial fibrillation in patients with degenerative mitral regurgitation. J Heart Valve Dis 16:8–12

    PubMed  Google Scholar 

  39. Osranek M, Fatema K, Qaddoura F, Al-Saileek A, Barnes ME, Bailey KR, Gersh BJ, Tsang TS, Zehr KJ, Seward JB (2006) Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. J Am Coll Cardiol 48:779–786

    Article  PubMed  Google Scholar 

  40. Barnes ME, Miyasaka Y, Seward JB, Gersh BJ, Rosales AG, Bailey KR, Petty GW, Wiebers DO, Tsang TS (2004) Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation. Mayo Clin Proc 79:1008–1014

    Article  PubMed  Google Scholar 

  41. Tani T, Tanabe K, Ono M, Yamaguchi K, Okada M, Sumida T, Konda T, Fujii Y, Kawai J, Yagi T, Sato M, Ibuki M, Katayama M, Tamita K, Yamabe K, Yamamuro A, Nagai K, Shiratori K, Morioka S (2004) Left atrial volume and the risk of paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 17:644–648

    Article  PubMed  Google Scholar 

  42. Moller JE, Hillis GS, Oh JK, Seward JB, Reeder GS, Wright RS, Park SW, Bailey KR, Pellikka PA (2003) Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation 107:2207–2212

    Article  PubMed  Google Scholar 

  43. Rossi A, Cicoira M, Zanolla L, Sandrini R, Golia G, Zardini P, Enriquez-Sarano M (2002) Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy. J Am Coll Cardiol 40:1425–1430

    Article  PubMed  Google Scholar 

  44. Menon SC, Ackerman MJ, Cetta F, O’Leary PW, Eidem BW (2008) Significance of left atrial volume in patients <20 years of age with hypertrophic cardiomyopathy. Am J Cardiol 102:1390–1393

    Article  PubMed  Google Scholar 

  45. Losi MA, Betocchi S, Barbati G, Parisi V, Tocchetti CG, Pastore F, Migliore T, Contaldi C, Caputi A, Romano R, Chiariello M (2009) Prognostic significance of left trial volume dilatation on patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 22:76–81

    Article  PubMed  Google Scholar 

  46. Losi MA, Betocchi S, Aversa M, Lombardi R, Mirnda M, D’Alessandro G, Ccce A, Tocchetti C, Brbati G, Chiariello M (2004) Determinants of atrial fibrillation development in patients with hypertrophic cardiomyopathy. Am J Cardiol 94:895–900

    Article  PubMed  Google Scholar 

  47. Leung DY, Chi C, Allman C, Boyd A, Ng AC, Kadappu KK, Leung M, Thomas L (2010) Prognostic implications of left atrial volume index in patients in sinus rhythm. Am J Cardiol 105:1635–1639

    Article  PubMed  Google Scholar 

  48. Toh N, Kanzaki H, Nkatani S, Ohara T, Kim J, Kusano KF, Hashimura K, Ohe T, Ito H, Kitakaze M (2010) Left atrial volume combined with atrial pump function identifies hypertensive patients with a history of paroxysmal atrial fibrillation. Hypertension 55:1150–1156

    Article  CAS  PubMed  Google Scholar 

  49. Jaubert MP, Armero S, Bonello L, Nicoud A, Sbragia P, Paganelli F, Argues S (2010) Predictors of B-type natriuretic peptide and left atrial volume index in patients with preserved left ventricular systolic function: an echocardiographic-catheterization study. Arch Cardiovasc Dis 103:3–9

    Article  PubMed  Google Scholar 

  50. Baltabaeva A, Marciniak M, Bijnens B, Parsai C, Moggridge J, Antonios TF, Macgregor GA, Sutherland GR (2009) How to detect early left atrial remodelling and dysfunction in mild-to-moderate hypertension. J Hypertens 27:2086–2093

    Article  CAS  PubMed  Google Scholar 

  51. Stevens SM, Farzaneh-Far R, Na B, Whooley MA, Schiller NB (2009) Development of an echocardiographic risk-stratification index to predict heart failure in patients with stable coronary artery disease: the Heart and Soul study. JACC Cardiovasc Imaging 2:11–20

    Article  PubMed  Google Scholar 

  52. Yoshida C, Nakao S, Goda A, Naito Y, Matsumoto M, Otsuka M, Shimoshikiryo M, Eguchi A, Lee-Kawabata M, Tsujino T, Masuyama T (2009) Value of assessment of left atrial volume and diameter in patients with heart failure but with normal left ventricular ejection fraction and mitral flow velocity pattern. Eur J Echocardiogr 10:278–281

    Article  PubMed  Google Scholar 

  53. Cho IJ, Pyun WB, Shin GJ (2009) The influence of the left ventricular geometry on the left atrial size and left ventricular filling pressure in hypertensive patients, as assessed by echocardiography. Korean Circ J 39:145–150

    Article  PubMed  Google Scholar 

  54. Galrinho A, Branco LM, Soares RM, Miranda F, Leal A, Ferreira RC (2009) Left atrial volume: an old echocardiographic measure with renewed prognostic significance: a study in patients with dilated cardiomyopathy. Rev Port Cardiol 28:1049–1060

    PubMed  Google Scholar 

  55. Beinart R, Boyko V, Schwammenthal E, Kuperstein R, Sagie A, Hod H, Maatetzky S, Behar S, Eldar M, Feinberg MS (2004) Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol 44:327–334

    Article  PubMed  Google Scholar 

  56. Yamaguchi K, Taanabe K, Tani T, Yagi T, Fujii Y, Konda T, Kawai J, Sumida T, Morioka S, Kihara Y (2006) Left atrial volume in normal Japanese adults. Circ J 70:285–288

    Article  PubMed  Google Scholar 

  57. Ujino K, Barnes ME, Cha SS, Langins AP, Bailey KR, Seward JB, Tsang TS (2006) Two-dimensional echocardiographic methods for assessment of left atrial volume. Am J Cardiol 98:1185–1188

    Article  PubMed  Google Scholar 

  58. Jiamsripong P, Honda T, Reuss R, Hurst T, Chliki HP, Grill DE, Schneck SL, Tyler R, Khandheria K, Lester SJ (2008) Three methods for evaluation of left atrial volume. Eur J Echocardiogr 9:351–355

    PubMed  Google Scholar 

  59. Kircher B, Abott JA, Pau S, Gould RG, Himelman RB, Higgins CB et al (1991) Left atrial volume determination by biplane two dimensional echocardiography: validation by cine-computed tomography. Am Heart J 121:864–871

    Article  CAS  PubMed  Google Scholar 

  60. Rodevan O, Bjornerheim R, Ljosland M, Maehle J, Smith HJ, Ihlen H (1999) Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Cardiovasc Imaging 15:397–410

    Article  CAS  Google Scholar 

  61. Keller AM, Gopal AS, King DL (2000) Left and right atrial volume by freehand three-dimensional echocardiography: in vivo validation using magnetic resonance imaging. Eur J Echocardiogr 1:55–65

    Article  CAS  PubMed  Google Scholar 

  62. Jenkins C, Bricknell K, Marwick TH (2005) Use of real-time three-dimensional echocardiography to measure left atrial volume: a comparison with other echocardiographic techniques. J Am Soc Echocardiogr 18:991–997

    Article  PubMed  Google Scholar 

  63. Kawai J, Tanabe K, Wng CL, Tani T, Yagi T, Shiotani H, Moriok S (2004) Comparison of left trial size by freehand scanning three-dimensional echocardiography and two-dimensional echocardiography. Eur J Echocardiogr 5:18–24

    Article  CAS  PubMed  Google Scholar 

  64. Artang R, Migrino RQ, Harmann L, Bowers M, Woods TD (2009) Left atrial volume measurement with automated border detection by 3-dimensional echocardiography: comparison with magnetic resonance imaging. Cardiovasc Ultrasound 7:16

    Article  PubMed  Google Scholar 

  65. Vasan RS, Larson MG, Levy D, Evans JC, Benjamin EJ (1997) Distribution and categorization of echocardiographic measurements in relation to reference limits: the Framingham Heart Study: formulation of a height- and sex-specific classification and its prospective validation. Circulation 96:1863–1873

    CAS  PubMed  Google Scholar 

  66. Knutsen KM, Stugaard M, Michelsen S, Otterstad JE (1989) M-mode echocardiographic findings in apparently healthy, nonathletic Norwegians aged 20–70 years Influence of age, sex and body surface area. J Intern Med 225:111–115

    Article  CAS  PubMed  Google Scholar 

  67. Thomas L, Levett K, Boyd A, Leung DY, Schiller NB, Ross DL (2002) Compensatory changes in atrial volumes with normal aging: is atrial enlargement inevitable? J Am Coll Cardiol 40:1630–1635

    Article  PubMed  Google Scholar 

  68. Gutman J, Wang YS, Wahr D, Schiller NB (1983) Normal left atrial function determined by 2-dimensional echocardiography. Am J Cardiol 51:336–340

    Article  CAS  PubMed  Google Scholar 

  69. Wang Y, Gutman JM, Heilbrom D, Wahr D, Schiller NB (1984) Atrial volume in a normal adult population by two-dimensional echocardiography. Chest 86:595–601

    Article  CAS  PubMed  Google Scholar 

  70. Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R (2010) Ethnicity-related differences in left ventricular function, structure and geometry: a population study of UK Indian Asian and European white subjects. Heart 96:466–471

    Article  PubMed  Google Scholar 

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  1. City Hospital, University of Birmingham Centre for Cardiovascular Sciences, Birmingham, B18 7QH, UK

    Chee W. Khoo, Suresh Krishnamoorthy, Hoong Sern Lim & Gregory Y. H. Lip

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  1. Chee W. Khoo
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  2. Suresh Krishnamoorthy
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Khoo, C.W., Krishnamoorthy, S., Lim, H.S. et al. Assessment of left atrial volume: a focus on echocardiographic methods and clinical implications. Clin Res Cardiol 100, 97–105 (2011). https://doi.org/10.1007/s00392-010-0222-y

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