Changes in left atrial structure and function over a decade in the general population

Flemming Javier Olsen*, Niklas Dyrby Johansen, Kristoffer Grundtvig Skaarup, Mats Christian Højbjerg Lassen, Kirstine Ravnkilde, Peter Schnohr, Gorm Boje Jensen, Jacob Louis Marott, Peter Søgaard, Rasmus Møgelvang, Tor Biering-Sørensen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

5 Citations (Scopus)


AIMS: Assessing left atrial (LA) size and function is an important part of the echocardiographic examination. We sought to assess how LA size and function develop over time, and which clinical characteristics promote atrial remodelling.

METHODS AND RESULTS: We examined longitudinal changes of the LA between two visits in the Copenhagen City Heart Study (n = 1065). The median time between the examinations was 10.4 years. LA measurements included: maximal LA volume (LAVmax), minimal LA volume (LAVmin), and LA emptying fraction (LAEF). Clinical and echocardiographic accelerators were determined from linear regression. The value of LA remodelling for predicting incident atrial fibrillation (AF) and heart failure (HF) was examined by Cox proportional hazards regressions. During follow-up, LAVmax and LAVmin significantly increased by 8.3 and 3.5 mL/m2, respectively. LAEF did not change. Age and AF were the most impactful clinical accelerators of LA remodelling with standardized beta-coefficients of 0.17 and 0.28 for changes in LAVmax, and 0.18 and 0.38 for changes in LAVmin, respectively. Left ventricular (LV) systolic function, diameter, and mass were also significant accelerators of LA remodelling. Changes in both LAVmax and LAVmin were significantly associated with incident AF [n = 46, ΔLAVmax: HR = 1.06 (1.03-1.09), P < 0.001 and ΔLAVmin: HR = 1.14 (1.10-1.18), P < 0.001, per 1 mL/m2 increase] and HF [n = 27, ΔLAVmax: HR = 1.08 (1.04-1.12), P < 0.001 and ΔLAVmin: HR = 1.13 (1.09-1.18), P < 0.001, per 1 mL/m2 increase].

CONCLUSION: Both maximal and minimal LA volume increase over time. Clinical accelerators included age and AF. LV structure and systolic function also accelerate LA remodelling. LA remodelling poses an increased risk of clinical outcomes.

Original languageEnglish
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number1
Pages (from-to)124-136
Number of pages13
Publication statusPublished - 1 Jan 2022
Externally publishedYes

Bibliographical note

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email:


  • echocardiography
  • left atrium
  • longitudinal
  • remodelling
  • Atrial Remodeling
  • Ventricular Function, Left
  • Humans
  • Atrial Function, Left
  • Heart Atria/diagnostic imaging
  • Atrial Fibrillation/complications


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