State-of-the-Art Paper
Left Atrial Size: Physiologic Determinants and Clinical Applications

https://doi.org/10.1016/j.jacc.2006.02.048Get rights and content
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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.

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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