Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2017 Feb;10(2):e005379.
doi: 10.1161/CIRCIMAGING.116.005379.

Left Atrial Structure in Relationship to Age, Sex, Ethnicity, and Cardiovascular Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis)

Filip Zemrak  1 , Bharath Ambale-Venkatesh  1 , Gabriella Captur  1 , Jonathan Chrispin  1 , Ela Chamera  1 , Mohammadali Habibi  1 , Saman Nazarian  1 , Saidi A Mohiddin  1 , James C Moon  1 , Steffen E Petersen  1 , João A C Lima  1 , David A Bluemke  2
Affiliations
Multicenter Study

Left Atrial Structure in Relationship to Age, Sex, Ethnicity, and Cardiovascular Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis)

Filip Zemrak et al. Circ Cardiovasc Imaging. 2017 Feb.

Abstract

Background: Left atrial (LA) size is a marker of diastolic function and is associated with atrial fibrillation and cardiovascular outcomes. However, there are no large population studies measuring LA structure. The relationship of demographics and cardiovascular risk factors to LA size is largely unknown. This study aimed to determine associations of LA size with demographic factors, cardiac structure and function, and cardiovascular risk factors.

Methods and results: LA volume indexed to body surface area was measured by cardiovascular magnetic resonance steady-state free precession and fast gradient echo cine long- and short-axis images in 2576 asymptomatic participants of MESA ([Multi-Ethnic Study of Atherosclerosis] 68.7 years, 53.0% women, white 42.2%, Chinese American 12.0%, black 24.5%, and Hispanic 21.2%) using biplane and short-axis images. The mean LA volume index was 36.5±11.4 mL/m2 in the entire cohort and 35.5±10.1 mL/m2 in subjects free of cardiovascular risk factors (n=283). Multivariable analysis included adjustment for demographics, ethnicity, cardiovascular risk factors, serological studies, socioeconomic status, left ventricular structure, and medications. In the adjusted analysis, age (β=0.2 mL/m2 per year, P<0.0001), male sex (β=-4.2 mL/m2, P<0.0001), obesity (β=1.3 mL/m2, P<0.01), end-diastolic volume index (β=0.4 mL/m2, P<0.0001), Chinese American (β=-2.6 mL/m2, P<0.0001), and Hispanic (β=1.1 mL/m2, P<0.05) ethnicities were associated with LA volume index. Diabetes mellitus and smoking were not associated with LA volume index. LA volumes measured by steady-state free precession were 3% larger than by fast gradient echo cine cardiovascular magnetic resonance (P<0.001).

Conclusions: Age, sex, ethnicity and left ventricular structural parameters were associated with LA size. Importantly, the study provides reference values of normal LA volume index.

Keywords: body surface area; magnetic resonance imaging.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Measurement of left atrial volume in left ventricular systolic phase. A and B – SSFP horizontal and vertical long axis cine images, C and D – fGRE horizontal and vertical long axis cine, E – SSFP short axis cine sequence.
Figure 2
Figure 2
Comparison of LA volume index derived from the short axis stack (SAX) and biplanar methods using Bland-Altman plot. SD – standard deviation.
Figure 3
Figure 3
Comparison of LA volume index derived from biplanar measurements on SSFP and fGRE using Bland-Altman plot. SD – standard deviation
Figure 4
Figure 4
Bland-Altman analysis demonstrating an excellent inter-observer variability in biplanar measurement of the LA volume index. SD – standard deviation.
See this image and copyright information in PMC

Comment in

References

    1. Simek CL, Feldman MD, Haber HL, Wu CC, Jayaweera AR, Kaul S. Relationship between left ventricular wall thickness and left atrial size: comparison with other measures of diastolic function. J Am Soc Echocardiogr. 1995;8:37–47. - PubMed
    1. Rossi A, Cicoira M, Florea VG, Golia G, Florea ND, Khan AA, Murray STM, Nguyen JT, O'Callaghan P, Anand IS, Coats A, Zardini P, Vassanelli C, Henein M. Chronic heart failure with preserved left ventricular ejection fraction: diagnostic and prognostic value of left atrial size. Int J Cardiol. 2006;110:386–392. - PubMed
    1. Rossi A, Cicoira M, Zanolla L, Sandrini R, Golia G, Zardini P, Enriquez-Sarano M. Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy. JAC. 2002;40:1425. - PubMed
    1. Melenovsky V, Borlaug BA, Rosen B, Hay I, Ferruci L, Morell CH, Lakatta EG, Najjar SS, Kass DA. Cardiovascular Features of Heart Failure With Preserved Ejection Fraction Versus Nonfailing Hypertensive Left Ventricular Hypertrophy in the Urban Baltimore Community The Role of Atrial Remodeling/Dysfunction. JAC. 2007;49:198–207. - PubMed
    1. Dini FL, Cortigiani L, Baldini U, Boni A, Nuti R, Barsotti L, Micheli G. Prognostic value of left atrial enlargement in patients with idiopathic dilated cardiomyopathy and ischemic cardiomyopathy. AJC. 2002;89:518–523. - PubMed

Publication types

MeSH terms