Left atrium

LA size

LA pressure

LA function

An important statement that should not be missing in any echocardio-report is the dimension of the LA. Many diseases are related to the LA, like arrhythmias, systolic and diastolic heart failure, mitral valve disorders. The LA has an increasingly important role in echocardiography which can be seen from the measurements in time: first there was the M-mode measurement in PLAX and later on in 2D, then there was the length and width measurement in the AP4CH view. But nowerdays LA volume index (LAVI) is the standard, and there is even the ability to produce LA volume in 3D.

LA dimensions

ParameterWomenMen
NormalMildly
abnormal
Moderately
abnormal
Severely
abnormal
NormalMildly
abnormal
Moderately
abnormal
Severely
abnormal
LA diameter, cm2.7–3.83.9–4.24.3–4.6≥4.73.0–4.04.1–4.64.7–5.2≥5.2
LA diameter/BSA, cm/m²1.5–2.32.4–2.62.7–2.9≥3.01.5–2.32.4–2.62.7–2.9≥3.0
LA minor-axis dimension, cm2.9–4.54.6–4.95.0–5.4≥5.52.9–4.54.6–4.95.0–5.4≥5.5
LA minor-axis dimension/BSA, cm/m²1.7–2.52.6–2.82.9–3.1≥3.21.7–2.52.6–2.82.9–3.1≥3.2
LA area, cm²≤2020–3030–40>40≤2020–3030–40>40
LA volume, mL22–5253–6263–72≥7318–5859–6869–78≥79

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LA pressure

 

Estimate LAP by measuring the systolic blood pressure and the maximum mitral regurgitation velocity

LA function

Left atrial functions and stiffness according to age; results from the NORRE study (2018)
ParameterAge 20 -40Age 41 -60Age >60
Medial (IQR)Medial (IQR)Medial (IQR)
Reservoir function
LA strain (%)46,8 (42,3-52,4)40,9 (35,4-46,1)35,5 (30,9-41,9)
2D LAEF (%)71,3 (67,3-74,9)66,7(62,8-72,4)64,0 (58,1-69,5)
3D LAEF (%)58,4 (53,1-63,1)57,1 (52,2-61,3)55,6 (50,6-60,4)
Conduit function
LA passive strain (%)30,6 (26,8-36,5)24,1 (19,7-29,3)18,6 (14,7-22,6)
Pump function
LA active strain (%)15,6 (11,9-19,0)16,3 (13,2-19,6)16,8 (13,6-21,4)
Stiffness
E/é5,6 (4,8-6,7)6,8 (5,8-8,3)8,3 (7,1-9,8)
E/é / LA strain0,12 (0,10-0,15)0,16 (0,13-0,22)0,24 (0,18-0,29)
E/é / 2D LVEF0,08 (0,07-0,09)0,10 (0,09-0,12)0,14 (0,11-0,15)
E/é / 3D LVEF0,10 (0,08-0,12)0,11 (0,10-0,15)0,15 (0,13-0,17)
LA strain componentMean95% CICochrane QI2Ƭ2
Reservoir (%)39.4 38.0–40.81,653 (P < .001) 97.620.0
Conduit (%)23.020.7–25.2420 (P < .001)96.917.9
Contractile (%)17.416.0–19.0631 (P < .001)97.39.7

 

 

References

Eur Heart J Cardiovasc Imaging. 2018 Jun 1;19(6):630-638.
J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14
J Am Coll Cardiol. 2006 Mar 7;47(5):1018-2
J Am Coll Cardiol. 2014 Feb 18;63(6):493-505
J Am Soc Echocardiogr. 2017 Jan;30(1):59-70.e8