Left atrial volume quantification by transthoracic echocardiography versus cardiovascular magnetic resonance: a systematic review and meta-analysis

Journal article : Review

Heart failure (HF) with preserved ejection fraction (HFpEF) is diagnosed by symptoms and/ or markers of congestion with cardiac dysfunction despite ‘normal’ (preserved) left ventricular (LV) EF. Of the criteria, left atrial volume (LAV) is being increasingly used, with cardiovascular magnetic resonance (CMR) recognised as the gold standard for volumetric assessment. We searched databases for studies with LAV and indexed (LAVi) measurements obtained through both transthoracic echocardiography (TTE) and CMR. We identified 17 articles, encompassing 1203 individuals with cardiac disease. TTE showed more frequent measurement failure (6% [95% CI 2, 11]) compared to CMR (1% [0, 5]). TTE underestimated values compared to CMR, with a bias of -20mL [95% CI -30, -11] for LAV and − 9 mL/m2 [95% CI -13, -5] for LAVi (p < 0.001). TTE misclassified LA enlargement in 38% [95%CI 25, 52) of cases diagnosed by CMR. TTE systematically underestimates LAV and should be used with caution. Graphical abstract: Quantification of left atrial enlargement. Left atrial volume (LAV) enlargement is one of the imaging criteria to diagnose heart failure with preserved ejection fraction (HFpEF). While cardiovascular magnetic resonance (CMR) is recognised as the gold standard technique, transthoracic echocardiography (TTE) is routinely used to measure LAV. This review identified 17 articles, encompassing 1203 individuals who had LAV and/or indexed (LAVi) measurements obtained from both TTE and CMR. When compared to CMR, TTE showed higher failure rates (6% vs 1%), underestimated LA values, and misclassified LAV enlargement in 38% of cases diagnosed by CMR.

Authors: Mahmod, M; Bull, S; Kailayanathan, T; Davis, TA; Borlotti, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: The International Journal of Cardiovascular Imaging
• Volume: 41
• Issue: 9
• Pages: 1657-1669
• Publication date: 2025-07-23
• Acceptance date: 2025-06-25
• DOI: 10.1007/s10554-025-03455-1
• EISSN: 1573-0743
• ISSN: 1569-5794
• Language: English
• Keywords: Heart failure; Left atrial volume; Heart failure preserved ejection fraction; Diagnostic accuracy; Echocardiography; Magnetic resonance
• Subtype: Review