Changes in Left Atrial Size: What Your Echo Results Mean

Q: Changes in Left Atrial Size: What Your Echo Results Mean

Hello, is this the same hospital's examination? I'm unclear about why the numbers have changed. <br>I recommend returning for a follow-up appointment to discuss this with your attending physician to understand why there has been such a significant change within a year. <br>Changh

Ultrasound Inquiry

I had a cardiac ultrasound in November 2021, and I noticed the left atrial (LA) measurements, but the doctor said it was fine.
Recently, during a follow-up appointment on November 11, 2022, I also had a cardiac ultrasound.
Although the report is not out yet, I saw the images showing -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 cardiac ultrasound 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
Comments: (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 cardiac ultrasound 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
MMode/2D Measurements & Calculations RWT: 0.34 Time Measurements MM R-R interval: 0.82 sec
MMode/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] [0.5-2.1 cm] 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] [EPSS <0.8 cm] CO (Teich): 7.3 l/min [2.5-7.2 l/m] [RWT 0.22-0.42]
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
• Isovolumetric 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
Atrium
• 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 cardiac ultrasound results from one month apart last year?
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 (Kang Keng 1.25 mg once in the morning and once at night, and Sinopril 150 mg) since August last year due to APCs, and I have been taking them ever since, returning for check-ups every three months.
The doctor suggested another cardiac ultrasound, and although the complete report is not yet available, I saw the image showing -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? Will this lead to heart failure or something similar?

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

Dr. He Dongjin reply Cardiology

Hello, is this the same hospital's examination? I'm unclear about why the numbers have changed.
I recommend returning for a follow-up appointment to discuss this with your attending physician to understand why there has been such a significant change within a year.
Changhua Hospital cares about you.

Reply Date: 2022/11/20

More Info

Understanding changes in left atrial size is crucial for assessing heart health, especially when considering the implications of your echocardiogram results. Based on the information you've provided, it appears that your left atrial dimension (LA Dimen) has increased from 3.5 cm in August 2021 to 4.6 cm in November 2022. This increase indicates that your left atrium is indeed dilated, as normal left atrial dimensions typically range from 1.9 to 4.0 cm.

1. Is this left atrial enlargement? Does it require treatment?
Yes, a left atrial dimension of 4.6 cm does indicate left atrial enlargement. Left atrial enlargement can be a sign of underlying heart conditions, such as hypertension, mitral valve disease, or heart failure. It is often associated with an increased risk of atrial fibrillation, which can lead to further complications such as stroke.
Whether treatment is necessary depends on several factors, including the underlying cause of the enlargement, your overall heart function, and any symptoms you may be experiencing. Since your echocardiogram also noted mild mitral regurgitation and other findings, it would be prudent to discuss these results with your cardiologist. They may recommend lifestyle modifications, medications, or further diagnostic testing to determine the best course of action.

2. Why did the echocardiogram results vary so much within a month?
Variability in echocardiogram results can occur due to several reasons:
- Measurement Techniques: Different technicians may use slightly different techniques or angles when taking measurements, leading to variability in reported sizes.

- Physiological Changes: Your heart's size and function can change due to various factors, including fluid status, blood pressure, and heart rate at the time of the exam.

- Progression of Disease: If there is an underlying condition affecting your heart, it may have progressed in the month between your echocardiograms.

3. Can the left atrium suddenly exceed normal size in one month?
While it is unusual for the left atrium to change significantly in size over such a short period, it is not impossible. Factors such as acute changes in blood pressure, volume overload, or the onset of arrhythmias can contribute to rapid changes in cardiac chamber sizes.
Given that you have been experiencing symptoms such as noticeable heartbeats and chest discomfort, it is essential to monitor these changes closely. The medications you are taking for arrhythmia may also influence heart function and size, so it’s crucial to maintain regular follow-ups with your healthcare provider.

Conclusion and Recommendations
In summary, your echocardiogram results suggest left atrial enlargement, which warrants further evaluation. It is essential to have a detailed discussion with your cardiologist about the implications of these findings and the best management strategies moving forward. They may recommend additional tests, such as a Holter monitor or stress testing, to assess your heart's function more comprehensively.

In the meantime, maintaining a heart-healthy lifestyle is vital. This includes regular exercise, a balanced diet low in sodium and saturated fats, and managing stress. If you experience worsening symptoms, such as increased shortness of breath, palpitations, or chest pain, seek medical attention promptly. Your proactive approach to understanding your heart health is commendable, and working closely with your healthcare team will help ensure the best outcomes.

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