Improved identification of left atrial enlargement in patients with obesity

Accurate standardization of left atrium volume (LAV) in patients with obesity is challenging. The aim of this study was to investigate and to examine the relation between LAV indexed to height 2 and left atrial function in patients with moderate to severe obesity. Echocardiograms of patients with moderate to severe obesity (body mass index (BMI) ≥ 35 kg/m 2 ) without known cardiac disease were analyzed. LAV was indexed to body surface area (BSA) and height 2 , and patients were divided into those with or without left atrial enlargement (LAE) based on normalization using either BSA (LAE bsa ) or height 2 (LAE h2 ). Using speckle tracking echocardiography, LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct) were assessed as a measure of LA function. LA dysfunction was defined as LASct < 14%. A total of 142 patients were included in the analysis of whom 54.2% had LAE h2 and 18.3% LAE BSA . The LAE h2 group had significantly lower LASct (12.2% ± 3.2% vs. 13.6% ± 4.5%, p = 0.019) as compared to the patients without LAE h2 . Significantly more patients with LA dysfunction would be correctly identified by LAE h2 than by LAE BSA (41.5% vs. 15.0%, p < 0.001). In patients with moderate to severe obesity, the use of LAE h2 identified significantly more patients with decreased LA function. LAV h2 should be preferred over LAV BSA in patients with moderate to severe obesity.