Key result
In healthy adults, indexed maximal left atrial volume assessed by CCTA did not differ significantly between sexes but increased with age, with the 3D volumetric method yielding larger (51 vs 43 mL/m2) and more reproducible values than the area-length method.
Why the study?
Normal left atrial volume thresholds on CCTA remain poorly defined, and the optimal assessment method is unclear.
Observational (n=250)
No
This study establishes normal reference ranges for maximal left atrial volume and other cardiac chambers using CCTA, demonstrating that indexed LAVmax increases with age but does not differ by sex, and that 3D volumetric assessment is highly reproducible.
Provides CCTA LAVmax reference ranges by age, sex, and BSA; leaves open their prognostic value in prospective cohorts.
Aims Left atrial volume (LAV) is a recognized prognostic marker of cardiovascular events. However, normal LAV thresholds on cardiac computed tomography angiography (CCTA) remain poorly defined, and the optimal assessment method is unclear. Our aim was to determine normal reference values of maximal systolic LAV (LAVmax) and ventricular dimensions normalized by age, sex, and body surface area (BSA) from CCTA by using dedicated semi-automated analysis software. Methods and results This single-centre retrospective study included 250 healthy subjects with no cardiac history or significant CCTA abnormalities, stratified by sex and age. LAVmax was measured using both 3D and area–length methods, and all other cardiac chambers were analysed with dedicated 3D semi-automated software (Vitrea®). LAVmax increased significantly with age in both sexes but showed no sex difference when indexed to BSA. The 3D volumetric method was more reproducible (r = 0.86, P < 0.001) and yielded larger values compared with area–length method. Reference values for LAVmax and all cardiac chambers were provided for both sexes and each age group. Age, in concert with sex, was associated with significant differences in RV end-diastolic volume and LV ejection fraction (P-values 0.027 and 0.03). Conclusion Indexed LAVmax was not significantly different across sexes but increased with age. LAVmax can be reliably reported from CCTA datasets, with 3D volumetric method providing the largest and most reproducible values. Normal values for all cardiac chambers according to age categories and sex were also provided. These normative values enhance the clinical utility of routine CCTA beyond coronary imaging.
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Alos et al. (2025) conducted an observational in Healthy subjects (no prior cardiac disease) (n=250). 3D volumetric method vs. Area-length method was evaluated on Indexed maximal left atrial volume (LAVmax) in mL/m2 (p=<0.001). In healthy adults, indexed maximal left atrial volume assessed by CCTA did not differ significantly between sexes but increased with age, with the 3D volumetric method yielding larger (51 vs 43 mL/m2) and more reproducible values than the area-length method.
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