Filip Zemrak1, Bharath Ambale-Venkatesh1, Gabriella Captur1, Jonathan Chrispin1, Ela Chamera1, Mohammadali Habibi1, Saman Nazarian1, Saidi A Mohiddin1, James C Moon1, Steffen E Petersen1, João A C Lima1, David A Bluemke2. 1. From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.). 2. From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.). bluemked@nih.gov.
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.
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.
Authors: Shunsuke Natori; Shenghan Lai; J Paul Finn; Antoinette S Gomes; W Gregory Hundley; Michael Jerosch-Herold; Gregory Pearson; Shantanu Sinha; Andrew Arai; Joao A C Lima; David A Bluemke Journal: AJR Am J Roentgenol Date: 2006-06 Impact factor: 3.959
Authors: Jorge R Kizer; Jonathan N Bella; Vittorio Palmieri; Jennifer E Liu; Lyle G Best; Elisa T Lee; Mary J Roman; Richard B Devereux Journal: Am Heart J Date: 2006-02 Impact factor: 4.749
Authors: Peace C Madueme; Wojciech Mazur; Kan N Hor; Joshua T Germann; John L Jefferies; Michael D Taylor Journal: Pediatr Cardiol Date: 2013-11-17 Impact factor: 1.655
Authors: Alessandra Meris; Maria Amigoni; Hajime Uno; Jens Jakob Thune; Anil Verma; Lars Køber; Mikhail Bourgoun; John J McMurray; Eric J Velazquez; Aldo P Maggioni; Jalal Ghali; J Malcolm O Arnold; Steven Zelenkofske; Marc A Pfeffer; Scott D Solomon Journal: Eur Heart J Date: 2008-11-11 Impact factor: 29.983
Authors: Nadine Kawel-Boehm; Alicia Maceira; Emanuela R Valsangiacomo-Buechel; Jens Vogel-Claussen; Evrim B Turkbey; Rupert Williams; Sven Plein; Michael Tee; John Eng; David A Bluemke Journal: J Cardiovasc Magn Reson Date: 2015-04-18 Impact factor: 5.364
Authors: Nadine Kawel-Boehm; Scott J Hetzel; Bharath Ambale-Venkatesh; Gabriella Captur; Christopher J Francois; Michael Jerosch-Herold; Michael Salerno; Shawn D Teague; Emanuela Valsangiacomo-Buechel; Rob J van der Geest; David A Bluemke Journal: J Cardiovasc Magn Reson Date: 2020-12-14 Impact factor: 5.364
Authors: Henrique Doria de Vasconcellos; Theingi Tiffany Win; Ela Chamera; Seo Young Hong; Bharath Ambale Venkatesh; Patrick Young; Xiaoying Yang; Luisa Ciuffo; Ravi K Sharma; Masamichi Imai; Mohammadali Habibi; Colin O Wud; Susan R Heckbert; David A Bluemke; Joao A C Lima Journal: Acad Radiol Date: 2020-04-09 Impact factor: 3.173
Authors: Theo Pezel; Bharath Ambale Venkatesh; Henrique Doria De Vasconcellos; Yoko Kato; Mahsima Shabani; Eric Xie; Susan R Heckbert; Wendy S Post; Steven J Shea; Norrina B Allen; Karol E Watson; Colin O Wu; David A Bluemke; João A C Lima Journal: Hypertension Date: 2021-07-06 Impact factor: 9.897