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Is my risk of mortality high, given my LA enlargement and volumes?

I had a STEMI over two years ago at the age of 41. I am a fit female, however, 1/3 of my left ventricle apical area is akinetic. Thankfully, my EF remains at 53%. I have read numerous studies about left atrial volume with preserved EF. I understand if your volume is in a moderate-to-severe range, you have a higher risk of mortality? Right after my MI, my volume was measured via echo at 31. I have echoes every 6 months and it ranges from 30-33. It changes every echo.  I also realize this is subjective as well (as is EF estimation) however, typically my results always read "no significant change from prior echo". My concern here is the risk of mortality. Is my risk high with a mildly enlarged LA and volumes in the 32-24 range?

submitted by Andrea from Illinois on 8/26/2012


Atasu K. Nayak, MDby Texas Heart Institute cardiologist, Atasu Nayak, MD    

Thanks for the question. Increased LA volume index >32ml/sq meter  is a powerful predictor of mortality after acute heart attack and provides prognostic information incremental to clinical data and conventional measures of LV systolic and diastolic function. Similarly left atrial volume index >50 ml/sq. meter has predicted heart failure in ambulatory adults with coronary heart disease. Your LVEF is 53% which is in lower limit of normal range. I do not know why your LA volume is moderate-to-severely enlarged on the echocardiogram. There are many causes for an enlarged left atrium including valvular heart disease, hypertension, hypertrophic cardiomyopathy and ischemic heart disease.  Please discuss with your cardiologist about this finding on the echocardiogram, and  possible changes of medications, if needed. 

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Updated September 2012
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