Key result
BSA-normal/height²-enlarged LA volume classification occurred in 23.4% of HFpEF patients and was associated with a 1.630 higher adjusted E/e' (95% CI, 0.738–2.522) vs normal by both methods.
Why the study?
Whether associations between BMI and left atrial size differ when volume is expressed as absolute volume, indexed to BSA, or indexed to height squared, and whether discordant classification is associated with E/e′ in HFpEF, required clarification.
Does indexing left atrial volume to height squared versus body surface area alter the classification of left atrial enlargement and its association with E/e′ in adults with heart failure with preserved ejection fraction?
Observational (n=1,663)
Does indexing left atrial volume to height squared versus body surface area alter the classification of left atrial enlargement and its association with E/e′ in adults with heart failure with preserved ejection fraction?
Answers are grounded in this paper and cite their sources.
In patients with HFpEF, indexing left atrial volume to height squared rather than body surface area reclassifies nearly a quarter of BSA-normal patients as having LA enlargement, which correlates with higher E/e′ filling pressures.
Purpose To determine whether associations between body mass index (BMI) and left atrial (LA) size differ when LA volume is expressed as absolute volume, indexed to body surface area (BSA), or indexed to height squared, and whether discordant classification is associated with E/e′ in heart failure with preserved ejection fraction (HFpEF). Methods This retrospective observational study linked MIMIC‐IV and MIMIC‐IV‐ECHO. The complete‐indexation cohort comprised 1663 adults with a documented heart failure diagnosis, left ventricular ejection fraction ≥50%, and required body‐size and LA measurements. Multivariable models evaluated BMI associations with absolute LA volume, LAV/BSA, and LAV/height 2 . Discordance was defined as BSA‐normal but height 2 ‐enlarged; adjusted E/e′ was compared with the group normal by both methods. Results BMI was positively associated with absolute LA volume ( β = 0.345; 95% CI, 0.124–0.567), inversely associated with LAV/BSA ( β = −0.329; 95% CI, −0.456 to −0.203), and positively associated with LAV/height 2 ( β = 0.156; 95% CI, 0.077–0.236). Discordant classification occurred in 389 of 1663 participants (23.4%). Adjusted E/e′ was 1.630 higher (95% CI, 0.738–2.522) than in participants normal by both methods. The absolute reclassification proportion decreased to 9.6% with an alternative published height 2 threshold. Conclusion Body‐size normalization materially changed apparent LA enlargement in this selected HFpEF population. BSA‐normal/height 2 ‐enlarged classification was associated with higher E/e′, a noninvasive filling‐related marker, but was threshold‐dependent. These findings do not establish diagnostic superiority or prognostic benefit.
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Wu et al. (2026) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=1,663). Discordant LA volume classification (BSA-normal but height²-enlarged) vs. Normal LA volume by both BSA and height² indexation methods was evaluated on Adjusted E/e' ratio (MD 1.630, 95% CI 0.738-2.522). BSA-normal/height²-enlarged LA volume classification occurred in 23.4% of HFpEF patients and was associated with a 1.630 higher adjusted E/e' (95% CI, 0.738–2.522) vs normal by both methods.
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