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Updated: Oct 10, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Left atrial structure and function are associated with cardiovascular outcomes independent of left ventricular
Zahra Raisi-Estabragh1,2, Celeste McCracken3, Dorina Condurache4
1William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
Insights
Left atrial function, measured by left atrial ejection fraction (LAEF), is linked to cardiovascular disease (CVD) risk and outcomes, independent of left ventricular function. These findings highlight LAEF
Area of Science:
- Cardiology
- Biomedical Imaging
- Public Health
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality worldwide.
- Left ventricular (LV) structure and function are established predictors of CVD.
- The independent contribution of left atrial (LA) structure and function to CVD risk is less understood.
Purpose of the Study:
- To evaluate the associations of LA structure and function with prevalent and incident CVD.
- To determine if these associations are independent of LV metrics.
- To explore the clinical utility of LA measures for disease prediction.
Main Methods:
- Utilized cardiovascular magnetic resonance (CMR) imaging data from 25,896 UK Biobank participants.
- Assessed LA maximum volume (LAV) and LA ejection fraction (LAEF), along with LV metrics.
- Employed multivariable regression models adjusted for numerous covariates, including vascular risk factors and demographics.
Main Results:
- Lower LAEF was significantly associated with diabetes, smoking, and all prevalent and incident CVDs.
- Smaller LAV was associated with diabetes, smoking, and high cholesterol.
- Hypertension, ischaemic heart disease (IHD), atrial fibrillation (AF), incident stroke, and CVD mortality were associated with larger LAV.
- LA metrics, particularly LAEF, showed consistent associations with incident CVDs, independent of LV metrics.
Conclusions:
- LA structure and function measures, specifically LAEF and LAV, are significantly associated with major cardiovascular outcomes.
- These LA metrics provide valuable information for CVD risk stratification and outcome prediction, independent of LV function.
- LA measures hold potential clinical utility for enhancing CVD diagnosis and prognosis.
Aims:
We evaluated the associations of left atrial (LA) structure and function with prevalent and incident cardiovascular disease (CVD), independent of left ventricular (LV) metrics, in 25 896 UK Biobank participants.
Methods And Results:
We estimated the association of cardiovascular magnetic resonance (CMR) metrics [LA maximum volume (LAV), LA ejection fraction (LAEF), LV mass : LV end-diastolic volume ratio (LVM : LVEDV), global longitudinal strain, and LV global function index (LVGFI)] with vascular risk factors (hypertension, diabetes, high cholesterol, and smoking), prevalent and incident CVDs [atrial fibrillation (AF), stroke, ischaemic heart disease (IHD), myocardial infarction], all-cause mortality, and CVD mortality. We created uncorrelated CMR variables using orthogonal principal component analysis rotation. All five CMR metrics were simultaneously entered into multivariable regression models adjusted for sex, age, ethnicity, deprivation, education, body size, and physical activity. Lower LAEF was associated with diabetes, smoking, and all the prevalent and incident CVDs. Diabetes, smoking, and high cholesterol were associated with smaller LAV. Hypertension, IHD, AF (incident and prevalent), incident stroke, and CVD mortality were associated with larger LAV. LV and LA metrics were both independently informative in associations with prevalent disease, however LAEF showed the most consistent associations with incident CVDs. Lower LVGFI was associated with greater all-cause and CVD mortality. In secondary analyses, compared with LVGFI, LV ejection fraction showed similar but less consistent disease associations.
Conclusion:
LA structure and function measures (LAEF and LAV) demonstrate significant associations with key prevalent and incident cardiovascular outcomes, independent of LV metrics. These measures have potential clinical utility for disease discrimination and outcome prediction.
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