September 5, 2026Journal of the American College of Cardiology598 citationsOpen Access
Diastolic dysfunction and left atrial volume
Key Result
Worsening diastolic dysfunction was associated with increased left atrial volume index, with grade II and grades III-IV DD associated with 24% and 62% larger LA volumes, respectively (p<0.0001).
Key Points
- To evaluate the pathophysiological and diagnostic relationship between left atrial volume enlargement and left ventricular diastolic dysfunction.
- Literature review analyzing echocardiographic parameters used to quantify left atrial volume and assess diastolic performance.
- Evaluation of left atrial volume index thresholds in grading diastolic dysfunction and estimating filling pressures.
- Left atrial enlargement directly reflects sustained elevation of left ventricular filling pressures over time.
- Increased left atrial volume index provides independent diagnostic and prognostic utility across all stages of diastolic dysfunction.
Study Design
Type
Cross-Sectional (n=2,042)
Structured PICO
Is diastolic dysfunction associated with left atrial enlargement and mortality in the general population?
P
Population
2,042 residents aged ≥45 years from Olmsted County, Minnesota, evaluated with Doppler echocardiography to assess the association between diastolic dysfunction and left atrial volume.
O
Outcome
Association between diastolic dysfunction (DD) grade and left atrial volume indexed to body surface area (LAVi)surrogate
Diastolic dysfunction is strongly associated with left atrial remodeling and serves as a stronger independent predictor of mortality than left atrial volume in the general population.
Main Result
Effect estimate: 24% larger for grade II, 62% larger for grade III-IV
p-value: p=<0.0001
Abstract
OBJECTIVES: We examined the association between diastolic function and left atrial volume indexed to body surface area (LAVi) in a population-based study. BACKGROUND: Atrial enlargement has been suggested as a marker of the severity and duration of diastolic dysfunction (DD). However, the association between DD and atrial enlargement and their individual prognostic implications in the population is poorly defined. METHODS: A cross-sectional sample of Olmsted County, Minnesota, residents > or =45 years of age (n=2,042) underwent comprehensive Doppler echocardiography and medical record review. RESULTS: The LAVi increased with worsening DD: 23 +/- 6 ml/m2 (normal), 25 +/- 8 ml/m2 (grade I DD), 31 +/- 8 ml/m2 (grade II DD), 48 +/- 12 ml/m2 (grades III to IV DD). In bivariate analyses, age, left ventricular mass index, and DD grade were positively associated, whereas female gender and ejection fraction (EF) were inversely associated with LAVi (p <0.001 for all). When controlling for age, gender, cardiovascular (CV) disease, EF, and left ventricular mass, grade II DD was associated with a 24%, and grade III to IV DD was associated with a 62% larger LA volume (p <0.0001 for both). The area under the receiver-operator characteristic curve for LAVi to detect grade I, grade II, or grade III to IV DD was 0.57, 0.81, and 0.98, respectively. Both DD and LAVi were predictive of all-cause mortality, but when controlling for DD, LAVi was not an independent predictor of mortality. CONCLUSIONS: These data suggest that DD contributes to LA remodeling. Indeed, DD is a stronger predictor of mortality; presumably it better reflects the impact of CV disease within the general population.
Cite This Study
Pritchett et al. (2004) conducted a cross-sectional in Diastolic dysfunction (n=2,042). Diastolic dysfunction vs. Normal diastolic function was evaluated on Left atrial volume indexed to body surface area (LAVi) (24% larger for grade II, 62% larger for grade III-IV, p=<0.0001). Worsening diastolic dysfunction was associated with increased left atrial volume index, with grade II and grades III-IV DD associated with 24% and 62% larger LA volumes, respectively (p<0.0001).