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
| Parameter | Women | Men | ||||||
|---|---|---|---|---|---|---|---|---|
| Normal | Mildly abnormal | Moderately abnormal | Severely abnormal | Normal | Mildly abnormal | Moderately abnormal | Severely abnormal |
|
| LA diameter, cm | 2.7–3.8 | 3.9–4.2 | 4.3–4.6 | ≥4.7 | 3.0–4.0 | 4.1–4.6 | 4.7–5.2 | ≥5.2 |
| LA diameter/BSA, cm/m² | 1.5–2.3 | 2.4–2.6 | 2.7–2.9 | ≥3.0 | 1.5–2.3 | 2.4–2.6 | 2.7–2.9 | ≥3.0 |
| LA minor-axis dimension, cm | 2.9–4.5 | 4.6–4.9 | 5.0–5.4 | ≥5.5 | 2.9–4.5 | 4.6–4.9 | 5.0–5.4 | ≥5.5 |
| LA minor-axis dimension/BSA, cm/m² | 1.7–2.5 | 2.6–2.8 | 2.9–3.1 | ≥3.2 | 1.7–2.5 | 2.6–2.8 | 2.9–3.1 | ≥3.2 |
| LA area, cm² | ≤20 | 20–30 | 30–40 | >40 | ≤20 | 20–30 | 30–40 | >40 |
| LA volume, mL | 22–52 | 53–62 | 63–72 | ≥73 | 18–58 | 59–68 | 69–78 | ≥79 |
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) | |||
|---|---|---|---|
| Parameter | Age 20 -40 | Age 41 -60 | Age >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/é | 5,6 (4,8-6,7) | 6,8 (5,8-8,3) | 8,3 (7,1-9,8) |
| E/é / LA strain | 0,12 (0,10-0,15) | 0,16 (0,13-0,22) | 0,24 (0,18-0,29) |
| E/é / 2D LVEF | 0,08 (0,07-0,09) | 0,10 (0,09-0,12) | 0,14 (0,11-0,15) |
| E/é / 3D LVEF | 0,10 (0,08-0,12) | 0,11 (0,10-0,15) | 0,15 (0,13-0,17) |
| LA strain component | Mean | 95% CI | Cochrane Q | I2 | Ƭ2 |
|---|---|---|---|---|---|
| Reservoir (%) | 39.4 | 38.0–40.8 | 1,653 (P < .001) | 97.6 | 20.0 |
| Conduit (%) | 23.0 | 20.7–25.2 | 420 (P < .001) | 96.9 | 17.9 |
| Contractile (%) | 17.4 | 16.0–19.0 | 631 (P < .001) | 97.3 | 9.7 |
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