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Left atrioventricular ratio (LA:LV): using left ventricular size as the reference for identifying maladaptive left
Luke W Spencer1,2, Sara Moura Ferreira3,4, Mauricio Milani3,5,6
1Heart, Exercise and Research Trials (HEART) Lab, St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia.
Insights
The left atrioventricular (LA:LV) ratio helps distinguish healthy from pathological cardiac remodelling. A lower LA:LV ratio indicates good fitness and physiological changes, while a higher ratio may signal underlying atrial pathology.
Area of Science:
- Cardiology
- Cardiac Physiology
- Echocardiography
Background:
- Cardiac remodelling of the left atrium (LA) and left ventricle (LV) is a response to various stimuli.
- The inter-dependence of LA and LV remodelling is often overlooked.
- The left atrioventricular ratio (LA:LV) may help differentiate physiological from pathological cardiac remodelling.
Purpose of the Study:
- To evaluate the utility of the LA:LV ratio in distinguishing adaptive from maladaptive cardiac remodelling.
- To assess the relationship between LA:LV ratio, cardiorespiratory fitness (VO2peak), and cardiac structural differences.
Main Methods:
- A multi-centre international cohort study involving 2,943 adults (1,600 healthy, 1,343 with pathology).
- Echocardiography was used to assess the LA:LV ratio (maximal LA end-systolic volume to LV end-diastolic volume).
- Cardiorespiratory fitness was assessed as peak oxygen uptake (VO2peak) and categorized into quartiles.
Main Results:
- Healthy individuals had a median LA:LV of 0.49, while those with pathology showed higher ratios (0.53, p<0.001), particularly in atrial fibrillation (0.60) and heart failure with preserved ejection fraction (0.70).
- The highest indexed LA volumes were observed in the highest VO2peak quartile, but the LA:LV ratio was highest in the lowest VO2peak quartile.
- Among individuals with enlarged LA volumes, the concordance with an elevated LA:LV ratio varied significantly by fitness level, being higher in lower fitness quartiles.
Conclusions:
- The LA:LV ratio is an effective discriminator of adaptive versus maladaptive atrial remodelling.
- A typical LA:LV ratio is approximately 0.5; lower ratios correlate with higher functional capacity and physiological remodelling.
- LA:LV ratios of 0.75 or higher may indicate pathological remodelling and warrant further investigation for atrial pathology, especially when considered in the context of cardiorespiratory fitness.
Introduction:
Remodelling of the left atrium (LA) and left ventricle (LV) occurs in response to pathological and physiological stimuli, yet their inter-dependence is often overlooked in clinical practice. The left atrioventricular ratio (LA:LV)-the ratio of maximal LA end-systolic volume (LAESV) to LV end-diastolic volume (LVEDV)-may offer valuable context for distinguishing physiological from pathological cardiac remodelling.
Methods And Results:
This study evaluated LA:LV, assessed via echocardiography, and cardiorespiratory fitness assessed as peak oxygen uptake (VO2peak) in a multi-centre international cohort spanning the cardiorespiratory fitness spectrum. Exercise capacity in healthy participants was categorized by VO2 peak quartiles, and cardiac structural differences were analysed. Among 2943 adults (1600 healthy, 1343 pathology), healthy individuals had a median LA:LV of 0.49 [0.38, 0.61], consistent with LVEDV being roughly twice the LAESV. Pathology revealed higher LA:LV ratios [0.53 (0.38-0.75), P < 0.001], with marked elevations amongst AF [0.60 (0.45-0.78)] and HFpEF [0.70 (0.51-0.88)]-a 30% increase vs. healthy adults. The highest indexed LA volumes occurred in the highest VO₂ peak quartile [Q4: 36 (28-46) mL/m²], while the LA:LV ratio was highest in Q1 [0.53 (0.42-0.69)]. Among participants with elevated LAVi (≥34 mL/m²), concordance with elevated LA:LV ratio (≥0.75) varied markedly by fitness level: ∼60% in Q1-Q2 vs. only 7% in Q4, highlighting the importance of fitness context when interpreting LA enlargement.
Conclusion:
The LA:LV ratio effectively discriminates between adaptive and maladaptive atrial remodelling. LA:LV is typically ∼0.5. Lower ratios correlate with higher functional capacity and physiological remodelling, whereas ratios ≥0.75 may indicate pathological remodelling and warrant consideration of atrial pathology.
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