Changes in Echocardiogram Results: Left Atrial Enlargement Concerns

Q: Changes in Echocardiogram Results: Left Atrial Enlargement Concerns

1. Two echocardiograms showed mild enlargement of the left atrium, which requires regular monitoring but does not necessitate treatment. 2. Measurements taken at different times by different operators will naturally have some variability. 3. The diagnosis of h

Echocardiogram

I would like to ask the director about my echocardiogram from last November.
I have been paying attention to the left atrial measurements, but the doctor said it was fine.
Recently, during my regular follow-up, I had another echocardiogram.
Although the report is not out yet, I noticed the images indicated - LA Dimension 4.6 cm - AV Cusp Sep 2.3 cm - AoR Diameter 3.2 cm ----------------------- LA/Ao (MM) 1.44 ------------------------ LVIDs 3.2 cm - LVPWd 1.2 cm - LVIDd 5.0 cm - IVSd 1.0 cm ------------------------ EDV (MM-Teich) 118 ml IVS/L VPW (MM) 0.833 ESV (MM-Teich) 41.0 ml FS (MM-Teich) 36.0% EF (MM-Teich) 65.3%.

The echocardiogram report from November 28 last year stated:
Tape: DVD G #236
Clinical Diagnosis: M-mode + Section Scan: Aortic Root (20∼37mm): 25 LAD (19∼40mm): 43 LVIDd (35∼51mm): 47 LVIDs (28∼35mm): 32 VS (6∼10mm): 10 PW (6∼10mm): 10
Comment: (M-mode, 2-D, Doppler & Color Flow Mapping)
1.
Preserved LV & RV systolic function, LVEF = 60%.

2.
Preserved LV diastolic function, E/A = 1.4, Em/Am = 1.5, E/Em = 7.5, Em = 12.4 cm/s.

3.
Dilated: LA.

4.
MR: Mild.

5.
TR: Minimal.

6.
PR: Mild.

7.
The TDI suggests decreased LV systolic reserve function.
(Lat Sm = 6.4 cm/sec)
The echocardiogram report from October 2 last year concluded:
• LV enlargement
• Preserved global contractility of the left ventricle
• LVEF by M-mode is 60.4%
• Regional wall motion abnormality, cause to be determined
• Grade I diastolic dysfunction (Impaired relaxation)
• MVP, borderline
• Mild mitral regurgitation
• Mild pulmonary regurgitation
• Mild tricuspid regurgitation
• Estimated systolic pulmonary artery pressure is 21.3 mmHg
M-mode/2D Measurements & Calculations RWT: 0.34
Time Measurements MM R-R interval: 0.82 sec
M-mode/2D Value References Ao root diameter: 3.1 cm [2.0-3.8 cm]
LVIDd: 5.8 cm [3.7-5.3 cm]
ACS: 1.9 cm [1.6-2.6 cm]
LVIDs: 3.9 cm [2.4-3.6 cm]
LA dimension: 3.5 cm [1.9-4.0 cm]
EDV (Teich): 166.6 ml [80-180 ml]
ESV (Teich): 65.9 ml [16-83 ml]
MV E-F slope: 17.3 cm/sec [8.0-15.0 cm/sec]
EF (Teich): 60.4% [50-70%]
IVSd: 1.0 cm [0.7-1.1 cm]
FS: 32.8% [FS 34-44%]
LVPWd: 1.0 cm [0.9-1.1 cm]
MM HR: 73.0 BPM [60-100 BPM]
CO (Teich): 7.3 l/min [2.5-7.2 l/m]
Doppler Measurements & Calculations Ao V2 max: 84.2 cm/sec LV V1 max PG: 2.4 mmHg Ao max PG: 2.8 mmHg LV V1 max: 77.0 cm/sec TR max velocity: 167.0 cm/sec sPAP: 21.3 mmHg TR max PG: 11.3 mmHg MV E max velocity: 82.9 cm/sec [>=50y, 62 ± 14, <50y, 72 ± 14] MV A max velocity: 56.8 cm/sec [>=50y, 59 ± 14, <50y, 40 ± 10] MV E/A: 1.5 [sPAP < 35 mmHg] MV deceleration time: 0.18 sec [DT 0.16-0.22 sec] LV IVRT: 0.05 sec [0.07-0.09 sec]
Ventricles
• Increased dimension of LV
• LVEF by M-mode is 60.4%
• Hypokinesis in the segments of LV including the anteroseptal wall
• Mitral inflow: E/A ratio: 1.5
• Isovolumic relaxation time is 0.05 sec
• Deceleration time of mitral inflow 0.18 sec
• Tissue Doppler: E’/A’ < 1
• Septal E’: 10.6 cm/s
• Lateral E’: 11.9 cm/s
• E/E’ (Lateral): 6.9
Atria
• Normal sizes of atrial chambers
Valves
• Increased thickness of MV with borderline elongated chordae of MV
I would like to ask:
1.
Is the left atrium enlarged? Does it require treatment?
2.
Why is there such a significant difference between the echocardiogram results from one month apart?
3.
Is it possible for the left atrium to suddenly exceed the normal range in just one month? Last year, in August 2021, the LA dimension was 3.5 cm [1.9-4.0 cm], but in November 2021, it suddenly became LAD (19∼40mm): 43, and now on November 20, 2022, it is -LA Dimension 4.6 cm.

I started taking antiarrhythmic medication (Kangken 1.25 mg twice daily and Sinopril 150 mg) in August last year due to APCs.
Initially, I had 8 APCs, but by November last year, they became frequent, with over 100 occurrences a day, and it wasn't until January this year that it reduced to 5-6 occurrences a month, with follow-ups every three months.
The doctor suggested another echocardiogram, and although the complete report is not yet available, I saw the image indicating -LA Dimension 4.6 cm, which made me wonder if my left atrium has enlarged again.
Is this a worsening condition? What should I do? Could this lead to heart failure? I seek your professional judgment.
Thank you.

Mr. Wang, 20~29 year old female. Ask Date: 2022/11/20

Dr. Wu Xueming reply Cardiology

1.
Two echocardiograms showed mild enlargement of the left atrium, which requires regular monitoring but does not necessitate treatment.
2.
Measurements taken at different times by different operators will naturally have some variability.
3.
The diagnosis of heart failure must be accompanied by symptoms of heart failure; you do not have heart failure.
It is recommended to adjust your lifestyle in addition to taking medication and to engage in regular exercise.
You may also ask your doctor to monitor a 24-hour Holter ECG; if the frequency of arrhythmias increases, medication adjustments can be made.

Reply Date: 2022/11/20

More Info

Understanding echocardiogram results, particularly regarding left atrial enlargement, can be quite concerning, especially when there are fluctuations in measurements over time. Let's address your questions systematically.

1. Is the left atrial dimension of 4.6 cm indicative of enlargement?
Yes, a left atrial dimension (LAD) of 4.6 cm is considered enlarged. Normal left atrial dimensions typically range from 1.9 to 4.0 cm. An enlarged left atrium can be a sign of various underlying conditions, including hypertension, mitral valve disease, or left ventricular dysfunction. The enlargement can lead to increased risk of atrial fibrillation, which you have experienced, and can also contribute to heart failure over time if not managed appropriately.

2. Why did the echocardiogram results vary so significantly between October and November of last year?
Variability in echocardiogram results can occur due to several factors. These include changes in your heart's hemodynamics, variations in the technique or equipment used during the echocardiogram, or even differences in the operator's interpretation. For instance, if your blood pressure was higher during one of the tests, it could lead to a temporary increase in left atrial size. Additionally, if you were experiencing more frequent atrial premature contractions (APCs) or other arrhythmias, this could also affect the measurements.

3. Is it possible for the left atrium to enlarge significantly in just one month?
While it is uncommon for the left atrium to enlarge dramatically in such a short time frame, it is not impossible, especially if there were acute changes in your cardiovascular status, such as increased blood pressure or worsening mitral regurgitation. The presence of frequent APCs could also contribute to changes in atrial size due to increased workload on the heart.

4. What should you do moving forward?
Given the enlargement of your left atrium and your history of arrhythmias, it is crucial to maintain regular follow-ups with your cardiologist. They may recommend further evaluations, such as a repeat echocardiogram, to monitor the left atrial size and function over time. Additionally, managing risk factors such as hypertension and hyperlipidemia is essential. This may involve lifestyle modifications (diet, exercise) and adherence to prescribed medications.

5. Could this lead to heart failure?
An enlarged left atrium can increase the risk of developing heart failure, particularly if it is associated with other heart conditions. However, it is not an immediate cause for alarm. With appropriate management and monitoring, many patients with left atrial enlargement can maintain good heart function. It is essential to work closely with your healthcare provider to monitor your heart health and adjust treatment as necessary.

In summary, while your left atrial enlargement is a concern, it is manageable with proper medical care. Regular follow-ups, lifestyle changes, and adherence to medication can help mitigate risks and maintain your heart health. Always feel free to discuss any concerns with your healthcare provider, as they can provide personalized advice based on your specific situation.

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