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Published on: July 20, 2022
Left atrial size: physiologic determinants and clinical applications
Walter P Abhayaratna1, James B Seward, Christopher P Appleton
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Left atrial enlargement, a marker of heart disease, predicts cardiovascular events. Its size reflects underlying pathophysiologic processes, not just age or gender.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Physiology
Background:
- Left atrial (LA) enlargement is linked to diastolic dysfunction and cardiovascular outcomes.
- Age and gender do not independently cause LA enlargement; it signifies pathological remodeling.
- LA size is a critical indicator in cardiovascular risk assessment.
Purpose of the Study:
- To review normal left atrial size and function.
- To outline clinical evaluation methods and pitfalls for LA size assessment.
- To discuss determinants of LA remodeling and prognostic implications.
Main Methods:
- Review of existing literature on left atrial size and function.
- Discussion of echocardiographic techniques for LA assessment.
- Analysis of factors influencing LA size and remodeling.
Main Results:
- LA enlargement is a marker of pathophysiologic processes, not solely aging or sex differences.
- Echocardiography is key for evaluating LA size and function.
- LA size has prognostic value for cardiovascular outcomes.
Conclusions:
- Left atrial size is a significant predictor of cardiovascular events.
- Further research is needed on LA remodeling, therapeutic modification, and outcome translation.
- LA volume assessment is an evolving tool for cardiovascular risk stratification.
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.
