Left atrial booster-pump function as a predictive parameter for atrial fibrillation in patients with severely dilated left atrium
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Updated: Sep 28, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Chia-Hung Yang1,2, Hao-Tien Liu1, Hui-Ling Lee3
1Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan.
Insights
Patients with severely dilated left atria (LA) and atrial fibrillation (AF) show impaired LA function. The late diastolic component of LA strain rate is the key predictor differentiating AF presence in these patients.
Area of Science:
- Cardiology
- Echocardiography
- Electrophysiology
Background:
- Severely dilated left atrium (LA) (≥50 mm) significantly increases atrial fibrillation (AF) risk.
- Distinguishing AF presence in patients with severely dilated LA requires further investigation of clinical and echocardiographic parameters.
Purpose of the Study:
- To identify clinical and echocardiographic parameters that differentiate patients with severely dilated LA who have AF from those who do not.
- To assess the role of LA function in the presence of AF in patients with severely dilated LA.
Main Methods:
- Retrospective cross-sectional study of 160 patients with LA dimension ≥50 mm, divided into no-AF, paroxysmal AF (PAF), and non-paroxysmal AF (non-PAF) groups.
- Echocardiographic parameters, including LA minimal volume index, LA emptying fraction, and LA strain rate, were analyzed.
- Multivariate analysis was performed to identify independent predictors of AF.
Main Results:
- The no-AF group exhibited higher body mass index, diabetes mellitus, and hypertension, but lower prevalence of rheumatic heart disease and sick sinus syndrome compared to AF groups.
- Echocardiography revealed significantly smaller LA minimal volume index and higher LA emptying fraction and longitudinal strain in the no-AF group.
- The late diastolic component of LA strain rate was the sole independent factor associated with AF presence (OR, 21.69; P<0.01).
Conclusions:
- Left atrial (LA) function is crucial in patients with severely dilated LA (≥50 mm) without atrial fibrillation (AF).
- The late diastolic component of LA strain rate is the only independent predictor for identifying AF in this patient cohort.
Background:
Left atrial (LA) dimension ≥50 mm had approximately four times the risk of developing atrial fibrillation (AF). The aim of this study was to investigate whether the application of clinical and echocardiographic parameters could differentiate between the patients having severely dilated left atrium with and without AF.
Methods:
This retrospective cross-sectional study enrolled consecutive patients with LA dimension ≥50 mm and divided them into three groups: no AF (no-AF), paroxysmal AF (PAF) and non-paroxysmal AF (non-PAF) groups. For PAF and non-PAF groups, all patients underwent radiofrequency ablation, and the echocardiographic parameters were obtained on the next day after ablation.
Results:
Our study population comprised 160 patients, including 80, 53, and 27 patients in the non-AF, PAF and non-PAF groups, respectively. The no-AF group had a significantly higher body mass index (kg/m2) (29.31±6.27, 27.58±4.12 and 26.57±2.81, P=0.01), and a higher prevalence of diabetes mellitus (DM) [31 (38.80%), 13 (25.00%) and 4 (14.80%), P=0.01] and hypertension [67 (83.80%), 34 (65.40%), and 19 (70.40%), P=0.04], but a lower prevalence of rheumatic heart disease (RHD) [3 (3.80%), 6 (11.50%) and 5 (18.50%), P=0.02] and sick sinus syndrome [0 (0.00%), 6 (11.50%) and 4 (14.80%), P=0.045]. Echocardiographic studies showed that the non-AF group had significantly smaller LA minimal volume index (24.89±9.74, 34.06±19.38 and 42.83±17.44 mL/m2, P<0.01), higher LA emptying fraction (51.99%±13.97%, 38.40%±15.96% and 33.89%±10.73%, P<0.01), longitudinal strain (23.87%±7.72%, 17.11%±8.52% and 12.38%±4.28%, P<0.01) and strain rate than the AF groups. The multivariate analysis showed that the late diastolic component of LA strain rate was the only independent factor associated with the presence of AF (odds ratio, 21.69; 95% CI, 9.77-48.13, P<0.01).
Conclusions:
LA function plays an important role in the absence of AF in patients with LA dimension ≥50 mm; the late diastolic component of LA strain rate was the only independent variable on multivariate analysis.
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