Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review

Liza Thomas, Thomas H. Marwick, Bogdan A. Popescu, Erwan Donal, Luigi P. Badano

Research output: Contribution to journalReview articlepeer-review


Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.

Original languageEnglish
Pages (from-to)1961-1977
Number of pages17
JournalJournal of the American College of Cardiology
Issue number15
Publication statusPublished - Apr 23 2019


  • 2-dimensional echocardiography
  • 3-dimensional echocardiography
  • heart failure with preserved ejection fraction
  • left atrial fibrosis
  • left atrium
  • left ventricular diastolic function
  • phasic function
  • speckle-tracking echocardiography
  • volumes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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