STATE-OF-THE-ART PAPER
Left Atrial Size
Physiologic Determinants and Clinical Applications
Walter P. Abhayaratna, MBBS, FRACP*,
James B. Seward, MD, FACC*,
Christopher P. Appleton, MD, FACC ,
Pamela S. Douglas, MD, FACC ,
Jae K. Oh, MD, FACC*,
A. Jamil Tajik, MD, FACC and
Teresa S.M. Tsang, MD, FACC*,*
* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
Cardiovascular Medicine Division, Duke University, Durham, North Carolina.
Manuscript received November 18, 2005;
revised manuscript received January 27, 2006,
accepted February 7, 2006.
* Reprint requests and correspondence: Dr. Teresa S. M. Tsang, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: tsang.teresa{at}mayo.edu).
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.
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Abbreviations and Acronyms
| | 2D = two-dimensional | | 3D = three-dimensional | | AF = atrial fibrillation | | CHF = congestive heart failure | | LA = left atrial/atrium | | LV = left ventricle/ventricular | | PVar = pulmonary venous flow reversal during atrial systole | | PVd = pulmonary venous flow during early ventricular diastole | | PVs1 = pulmonary venous flow during early ventricular systole | | PVs2 = pulmonary venous flow during late ventricular systole |
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