Left Atrial Volume and Geometry in Healthy Aging: The Cardiovascular Health Study

OBJECTIVES:  The left atrium is a validated marker of clinical and subclinical cardiovascular disease. Left atrial enlargement is often seen among older individuals; however, there are few population-based data regarding normal left atrial size among older persons, especially from those who are healthy, and from women. Furthermore, because the left atrium is a 3D structure, the commonly used parasternal long-axis diastolic diameter often underdiagnoses left atrial enlargement.

METHODS: We evaluated left atrial size in 230 healthy participants (mean age, 76┬▒5 years) free of prevalent cardiac disease, rhythm abnormality, hypertension, and diabetes selected from the Cardiovascular Health Study, a prospective community-based study of risk factors for cardiovascular disease in 5888 elderly participants. In addition to the standard long-axis measurement, we obtained left atrial superoinferior and lateral diameters and used these dimensions to estimate left atrial volume. These measurements were used to generate reference ranges for determining left atrial enlargement in older men and women, based on the 95% percentiles of the left atrial dimensions in healthy participants, both unadjusted, and after adjustment for age, height, and weight.

RESULTS: In healthy elderly subjects, indices of left atrial size do not correlate with age or height but with weight and other measures of body build.

CONCLUSIONS: These data provide normative reference values for left atrial size in healthy older women and men. The results should be useful for refining diagnostic criteria for left atrial dilation in the older population and may be relevant for cardiovascular risk stratification.


Gian Novaro

Gian Novaro

Director of Echocardiography
Department of Cardiology
Cleveland Clinic Florida
Weston, FL
Gian Novaro
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One Comment

  1. This study proposes a series of reference equations and normative values for LA dimensions and volumes in well-characterized older; and cardiovascular-healthy individuals.
    This is a very well designed study in a cohort of 230 subjects, which adds reference data to the literature. However, the LA measurements presented are to some degree an estimation based on mathematical formulas for ellipsoid structures. Wouldn’t a definite reference be more adequate if based using the gold-standard for chamber volume measurements which is MRI?

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