Ratio of Left Atrial and Ventricular Volume as New Marker of Atrial Cardiopathy and Stroke Risk

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial cardiopathy and ischemic stroke (n=40121). Intervention: Larger left atrial to ventricular volume (LA:LV) ratio vs. Normal LA:LV ratio / Left atrial volume indexed to body surface area (LAVi). Primary outcome: Incident ischemic stroke or transient ischemic attack (aHR 1.15, 95% CI 1.01-1.30, p=0.04).

Q: What does this research mean for the field?

A larger left atrial to ventricular volume ratio is significantly associated with an increased risk of incident ischemic stroke or transient ischemic attack, outperforming left atrial volume indexed to body surface area. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Julian Deseoe; Martin Hänsel; Lisa Herzog; Neda Davoudi; Andreas Luft; Cathérine Gebhard; Bjoern Menze; Beate Sick; Susanne Wegener

doi:10.1161/strokeaha.126.055551

June 18, 2026StrokeOpen Access

Ratio of Left Atrial and Ventricular Volume as New Marker of Atrial Cardiopathy and Stroke Risk

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Key result

Higher LA:LV ratio linked to ~15% higher risk of incident stroke or TIA.

aHR 1.15
95% CI 1.01-1.30
P=0.04
n=40,121

Why the study?

LAVi lacks specificity for atrial cardiopathy due to physiological remodeling, so the LA:LV ratio was evaluated as an improved marker of pathological atrial remodeling and its clinical sequelae.

Does the LA:LV ratio improve the prediction of incident ischemic stroke/TIA and the detection of atrial fibrillation compared to LAVi in patients without heart failure?

Key Points

To determine whether the left atrial to ventricular volume (LA:LV) ratio serves as a superior marker of atrial cardiopathy, incident ischemic stroke, and cognitive impairment compared with indexed left atrial volume (LAVi).
Analyzed 38,848 participants from the UK Biobank and 1,273 ischemic stroke patients from the University Hospital Zürich.
Assessed associations of LAVi and LA:LV ratio with incident ischemic stroke or transient ischemic attack using competing risks survival analysis and with cognitive function via linear regression.
Evaluated the diagnostic performance of both volume metrics for identifying atrial fibrillation or flutter as the cause of stroke in the clinical cohort.
In the UK Biobank, an elevated LA:LV ratio was significantly associated with incident ischemic stroke or transient ischemic attack (aHR, 1.15 [95% CI, 1.01–1.30]; P=0.04), whereas LAVi was not (aHR, 1.11 [95% CI, 0.97–1.26]; P=0.14).
A larger LA:LV ratio showed a stronger association with poorer cognitive function (regression coefficient, -0.024 [95% CI, -0.032 to -0.015]) than LAVi (regression coefficient, -0.010 [95% CI, -0.019 to -0.002]).
In stroke patients, LA:LV ratio significantly outperformed LAVi in identifying atrial fibrillation/flutter as the stroke cause (area under the receiver operating characteristic curve, 0.856 [95% CI, 0.803–0.908] vs 0.808 [95% CI, 0.750–0.866]; P=0.03).

Study Design

Type

Cohort (n=40,121)

Multicenter

Yes

Structured PICO

Does the LA:LV ratio improve the prediction of incident ischemic stroke/TIA and the detection of atrial fibrillation compared to LAVi in patients without heart failure?

P

Population

40,121 participants from the population-based UK Biobank cohort and a Swiss clinical cohort of ischemic stroke patients, evaluated for the association of LA:LV ratio with atrial cardiopathy sequelae.

E

Exposure

Measurement of left atrial to ventricular volume (LA:LV) ratio via cardiac magnetic resonance imaging (UKBB cohort) or echocardiography (USZ cohort).

C

Comparator

Left atrial volume indexed to body surface area (LAVi).

O

Outcome

Incident ischemic stroke or transient ischemic attack (TIA) in the UKBB cohort; identification of atrial fibrillation/flutter as the underlying cause of ischemic stroke in the USZ cohort.hard clinical

Main Result

Hazard Ratio: 1.15 (95% CI 1.01–1.3)

p-value: p=0.04

The LA:LV ratio outperforms traditional LAVi as an imaging marker of atrial cardiopathy, demonstrating stronger associations with incident ischemic stroke, cognitive decline, and atrial fibrillation as a stroke cause.

Limitations

Large sample size of the UK Biobank may lead to statistically significant but not clinically relevant associations
Low overall incidence of ischemic stroke/TIA in the UK Biobank
Associations with cognitive function are cross-sectional, limiting causal inference
Analysis of cortical volumes was not adjusted for total gray matter volume
Deliberate exclusion of subjects with heart failure, reduced ejection fraction, and LV dilation
Exclusion of patients with embolic stroke of undetermined source (ESUS) in the clinical stroke cohort
Most stroke patients without detected atrial fibrillation only underwent 48 hours of rhythm monitoring
Large sample size of the UKBB might detect statistically significant but not clinically relevant associations.
Low overall incidence of ischemic stroke/TIA in the population-based UKBB cohort.
Cross-sectional associations with cognitive function do not allow for inferring causality.
Did not adjust for total cortical gray matter volume, which could mask global cortical atrophy associations.
Excluded subjects with heart failure, reduced ejection fraction, and LV dilation, meaning findings do not apply to these groups.
Observational design precludes establishing causality regarding the mechanistic hypothesis of exercise and heart volumes.
Did not correlate or compare the LA:LV ratio with left atrial strain.

Implication

LA:LV ratio may refine atrial cardiopathy evaluation beyond LAVi; leaves open whether it improves stroke risk stratification or AF detection in practice.

Abstract

BACKGROUND: Atrial cardiopathy is an important cause of embolic stroke and a potential cause of cognitive impairment. Increased left atrial volume indexed to body surface area (LAVi) has been widely used as a marker for atrial cardiopathy. However, because physiological remodeling, for example, due to exercise, may also increase LAVi, it lacks specificity. Left atrial to ventricular volume (LA:LV) ratio has been suggested as an improved marker of atrial cardiopathy, allowing detection of imbalanced, pathological atrial remodeling. We investigated if LA:LV ratio is associated with different sequelae of atrial cardiopathy. METHODS: We analyzed data from 2 cohorts, the population-based UK Biobank cohort (n=38 848) and a cohort of patients with ischemic stroke from the University Hospital Zürich (n=1273). In the UK Biobank cohort, we compared the association of LAVi and LA:LV ratio with risk of incident ischemic stroke or transient ischemic attack ascertained from linked health records, using competing risks survival analysis. We also investigated the association with cognitive function using linear regression models. In the ischemic stroke patient cohort, we compared LAVi and LA:LV ratio for identifying atrial fibrillation/flutter as a cause of stroke. RESULTS: While LAVi was not significantly associated with risk of ischemic stroke/transient ischemic attack (aHR, 1.11 [95% CI, 0.97–1.26]; P =0.14), a larger LA:LV ratio was (aHR, 1.15 [95% CI, 1.01–1.30]; P =0.04). Besides, LA:LV ratio was more strongly associated with worse cognitive function. In a stroke patient cohort, LA:LV ratio significantly outperformed LAVi at identifying atrial fibrillation/flutter as underlying cause of ischemic stroke compared with LAVi (area under the receiver operating characteristic curve, 0.856 [95% CI, 0.803–0.908] versus 0.808 [95% CI, 0.750–0.866]; P =0.03). CONCLUSIONS: We provide evidence that LA:LV ratio is a strong, novel marker of atrial cardiopathy. Hence, LA:LV ratio has the potential to improve the diagnosis of atrial cardiopathy, facilitating the prophylaxis of ischemic stroke and maintaining brain health.

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Published by Stroke · CC BY-NC-ND

Cite This Study

Deseoe et al. (2026) conducted a cohort in Atrial cardiopathy and ischemic stroke (n=40,121). Larger left atrial to ventricular volume (LA:LV) ratio vs. Normal LA:LV ratio / Left atrial volume indexed to body surface area (LAVi) was evaluated on Incident ischemic stroke or transient ischemic attack (aHR 1.15, 95% CI 1.01-1.30, p=0.04). A larger left atrial to ventricular volume (LA:LV) ratio was associated with increased risk of incident ischemic stroke or TIA (aHR 1.15) and outperformed LAVi in identifying AF as stroke cause.

synapsesocial.com/papers/6a35982fdd3be7785e70ece2 https://doi.org/10.1161/strokeaha.126.055551

Topics

Atrial fibrillation

Persistent AF management

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Ratio of Left Atrial and Ventricular Volume as New Marker of Atrial Cardiopathy and Stroke Risk

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Ratio of Left Atrial and Ventricular Volume as New Marker of Atrial Cardiopathy and Stroke Risk

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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Topics

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