Left Atrial ReModeling in Disease: Association with Clinical Markers

Background: The role of left atrial (LA) enlargement has a significant and independent association with moderate and severe diastolic dysfunction, atrial fibrillation, and left ventricular (LV) end-diastolic volume. Clinical features of heart failure have shown a correlation with LV dilatation and LV ejection fraction (LV). Aims: Correlation of clinical features with substrates of cardiac remodeling, especially left atrial (LA) remodeling, has not been well-documented. We sought to determine the major clinical factors that are associated with LA enlargement in subjects with heart failure. Materials and Methods: We studied 200 patients who presented with breathlessness due to underlying cardiac disease. The association of clinical features of cardiac disease with LA remodeling was studied using three-dimensional echocardiography. Results: This was a cross-sectional study conducted between January 2016 and January 2017. We found that clinical features of heart failure such as breathlessness, elevated jugular venous pressure, dilated LV, diastolic dysfunction, severe mitral regurgitation, pulmonary hypertension, and abnormal tricuspid annular plane systolic excursion were significantly associated with LA enlargement. LA volume was significantly and independently associated with moderate and severe diastolic dysfunction, atrial fibrillation, lower hemoglobin levels, and LV diastolic size on echocardiography. The sensitivity and specificity of breathlessness with LA enlargement were not significant. Conclusions: Clinical features of heart failure, namely breathlessness, were significantly associated with LA enlargement. LA enlargement was not a sensitive or specific marker of breathlessness in heart failure