Atrial volume

Changed by Joachim Feger, 26 Oct 2021

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The atrial volumes refer to the blood volumes of the left or right atrium and the atrial volume index is the respective atrial volume corrected for the body surface area (BSA).

Usage

Atrial volumes are measured for the assessment of many congenital and acquired cardiac conditions causing left atrial or right atrial enlargement.

Measurement

Echocardiography

Methods include the disk summation technique (Simpson(Simpson’s method), 3D data sets or a biplane area-length method from apical four-chamber and two-chamber views. The left atrial volume the appendage is excluded from the measurement 1.

MRI

Widely-used postprocessing software solutions for cardiac MRI employ a combination of semi-automated feature recognition and manual contour correction based on the modified Simpson’s method using a stack of SFFP cine images in the short axis, horizontal long axis or transverse plane.

Similar to the end-diastolic and end-systolic ventricular volumes the atrial volumes might be determined by the sum of the computed left/right atrial cross-sectional areas determined by the endocardial contours at atrial enddiastoleend-diastole just before mitral or tricuspid valve opening (chosen as the images with the largest blood volume) accounting for slice thickness and gap 2,3.

Alternative methods include the employment of 3D modelling software or the biplane area-length method in the horizontal and vertical lengthlong axis that can be employed for measurement of the left atrial volume onstandard SSFP cine images 2,4.

The atrial volume index is calculated as AVatrial volume/BSA [mL/m2]

Interpretation

Normal values differ for the left and right atria depending on gender and age, imaging modality and slightly with the calculation method 1-3.

Echocardipography

Echocardiography

Left atrial volumes values on 2D echocardiography are typically smaller than on cardiac MRI or cardiac CT 1.

The recommended upper normal left atrial volume indexed for body surface area (BSA) is 34 ml/m2 for both women and men 1.

MRI

Normal values are derived for SSFP cine sequences from the updated publication by Kawel-Boehm 2:. Values above the normal indicate atrial dilatation.

Left atrium

Simpson’s method (left atrial appendage included) 2,3:

Women (adult):

  • maximum left atrial volume [mL]: 37-94 mL
  • maximum left atrial volume/BSA [mL/m2]: 25-53 mL/m2

Men (adult):

  • maximum left atrial volume [mL]: 42-115 mL
  • maximum left atrial volume/BSA [mL/m2]: 25-56 mL/m2

Biplane area-length method (left atrial appendage excluded) 2,4:

Women (adult):

  • maximum left atrial volume [mL]: 28-100 mL
  • maximum left atrial volume/BSA [mL/m2]: 17-61 mL/m2

Men (adult):

  • maximum left atrial volume [mL]: 31-112 mL 
  • maximum left atrial volume/BSA [mL/m2]: 17-59 mL/m2

    Values above the normal indicate left atrial dilatation.

Right atrium

Simpson’s method (right atrial appendage included) 2,3:

Women (adult):

  • maximum right atrial volume [mL]: 49-122 mL
  • maximum right atrial volume/BSA [mL/m2]: 31-69 mL/m2

Men (adult):

  • maximum right atrial volume [mL]: 59-158 mL 
  • maximum right atrial volume/BSA [mL/m2]: 32-79 mL/m2

Biplane area-length method (right atrial appendage excluded) 2,5:

Women (adult):

  • maximum right atrial volume [mL]: 24-81 mL
  • maximum right atrial volume/BSA [mL/m2]: 16-54 mL/m2

Men (adult):

  • maximum right atrial volume [mL]: 24-105 mL 
  • maximum right atrial volume/BSA [mL/m2]: 15-61 mL/m2

    Values above the normal indicate right atrial dilatation.

  • -<p>The <strong>atrial volumes</strong> refer to the blood volumes of the left or right atrium and the <strong>atrial volume index </strong>is the volume corrected for the <a href="/articles/body-surface-area">body surface area (BSA)</a>.</p><h4>Usage</h4><p>Atrial volumes are measured for the assessment of many congenital and acquired cardiac conditions causing left atrial or right atrial enlargement.</p><h4>Measurement</h4><h4>Echocardiography</h4><p>Methods include the disk summation technique (<a href="/articles/simpson-s-method">Simpson’s method</a>), 3D data sets or a biplane area-length method from apical four-chamber and two-chamber views. The left atrial volume the appendage is excluded from the measurement <sup>1</sup>.</p><h4>MRI</h4><p>Widely-used postprocessing software solutions for cardiac MRI employ a combination of semi-automated feature recognition and manual contour correction based on the modified <a href="/articles/simpson-s-method">Simpson’s method</a> using a stack of SFFP cine images in the short axis, horizontal long axis or transverse plane.</p><p>Similar to the end-diastolic and end-systolic ventricular volumes the atrial volumes might be determined by the sum of the computed left/right atrial cross-sectional areas determined by the endocardial contours at atrial enddiastole just before mitral or tricuspid valve opening (chosen as the images with the largest blood volume) accounting for slice thickness and gap <sup>2,3</sup>.</p><p>Alternative methods include the employment of 3D modelling software or the biplane area-length method in the horizontal and vertical length axis that can be employed for measurement of the left atrial volume on standard SSFP cine images <sup>2,4</sup>.</p><p>The atrial volume index is calculated as AV/BSA [mL/m<sup>2</sup>]</p><h4>Interpretation</h4><p>Normal values differ for the left and right atria depending on gender and age, imaging modality and slightly with the calculation method <sup>1-3</sup>.</p><h4>Echocardipography</h4><p>Left atrial volumes values on 2D echocardiography are typically smaller than on cardiac MRI or cardiac CT <sup>1</sup>.</p><p>The recommended upper normal left atrial volume indexed for body surface area (BSA) is 34 ml/m<sup>2 </sup>for both women and men <sup>1</sup>.</p><h4>MRI</h4><p>Normal values are derived for SSFP cine sequences from the updated publication by Kawel-Boehm <sup>2</sup>:</p><h4>Left atrium</h4><p>Simpson’s method (left atrial appendage included) <sup>2,3</sup>:</p><p><strong>Women (adult):</strong></p><p>maximum left atrial volume [mL]: 37-94 mL</p><p>maximum left atrial volume /BSA [mL/m<sup>2</sup>]: 25-53 mL/m<sup>2</sup></p><p><strong>Men (adult):</strong></p><p>maximum left atrial volume [mL]: 42-115 mL </p><p>maximum left atrial volume/BSA [mL/m<sup>2</sup>]: 25-56 mL/m<sup>2</sup></p><p> </p><p>Biplane area-length method (left atrial appendage excluded) <sup>2,4</sup>:</p><p><strong>Women (adult):</strong></p><p>maximum left atrial volume [mL]: 28-100 mL</p><p>maximum left atrial volume/BSA [mL/m<sup>2</sup>]: 17-61 mL/m<sup>2</sup></p><p><strong>Men (adult):</strong></p><p>maximum left atrial volume [mL]: 31-112 mL </p><p>maximum left atrial volume/BSA [mL/m<sup>2</sup>]: 17-59 mL/m<sup>2</sup></p><p> </p><p>Values above the normal indicate left atrial dilatation.</p><h4>Right atrium</h4><p>Simpson’s method (right atrial appendage included) <sup>2,3</sup>:</p><p><strong>Women (adult):</strong></p><p>maximum right atrial volume [mL]: 49-122 mL</p><p>maximum right atrial volume/BSA [mL/m<sup>2</sup>]: 31-69 mL/m<sup>2</sup></p><p><strong>Men (adult):</strong></p><p>maximum right atrial volume [mL]: 59-158 mL </p><p>maximum right atrial volume/BSA [mL/m<sup>2</sup>]: 32-79 mL/m<sup>2</sup></p><p> </p><p>Biplane area-length method (right atrial appendage excluded) <sup>2,5</sup>:</p><p><strong>Women (adult):</strong></p><p>maximum right atrial volume [mL]: 24-81 mL</p><p>maximum right atrial volume/BSA [mL/m<sup>2</sup>]: 16-54 mL/m<sup>2</sup></p><p><strong>Men (adult):</strong></p><p>maximum right atrial volume [mL]: 24-105 mL </p><p>maximum right atrial volume/BSA [mL/m<sup>2</sup>]: 15-61 mL/m<sup>2</sup></p><p> </p><p>Values above the normal indicate right atrial dilatation.</p><p> </p>
  • +<p>The <strong>atrial volumes</strong> refer to the blood volumes of the left or right atrium and the <strong>atrial volume index </strong>is the respective atrial volume corrected for the <a href="/articles/body-surface-area">body surface area (BSA)</a>.</p><h4>Usage</h4><p>Atrial volumes are measured for the assessment of many congenital and acquired cardiac conditions causing <a href="/articles/left-atrial-enlargement">left atrial</a> or <a href="/articles/right-atrial-enlargement">right atrial enlargement</a>.</p><h4>Measurement</h4><h5>Echocardiography</h5><p>Methods include the disk summation technique (Simpson’s method), 3D data sets or a biplane area-length method from apical four-chamber and two-chamber views. The <a href="/articles/left-atrial-appendage">left atrial appendage</a> is excluded from measurement <sup>1</sup>.</p><h5>MRI</h5><p>Widely-used postprocessing software solutions for <a href="/articles/cardiac-mri">cardiac MRI</a> employ a combination of semi-automated feature recognition and manual contour correction based on the modified Simpson’s method using a stack of SFFP <a href="/articles/cine-imaging-mri">cine images</a> in the short axis, horizontal long axis or transverse plane.</p><p>Similar to the <a href="/articles/end-diastolic-volume">end-diastolic</a> and <a href="/articles/end-sytolic-volume">end-systolic ventricular volumes</a> the atrial volumes might be determined by the sum of the computed left/right atrial cross-sectional areas determined by the endocardial contours at atrial end-diastole just before mitral or tricuspid valve opening (chosen as the images with the largest blood volume) accounting for slice thickness and gap <sup>2,3</sup>.</p><p>Alternative methods include the employment of 3D modelling software or the biplane area-length method in the horizontal and vertical long axis that can be employed for measurement of the left atrial volume on standard SSFP cine images <sup>2,4</sup>.</p><p>The atrial volume index is calculated as atrial volume/BSA [mL/m<sup>2</sup>]</p><h4>Interpretation</h4><p>Normal values differ for the left and right atria depending on gender and age, imaging modality and slightly with the calculation method <sup>1-3</sup>.</p><h5>Echocardiography</h5><p>Left atrial volumes values on 2D echocardiography are typically smaller than on cardiac MRI or cardiac CT <sup>1</sup>.</p><p>The recommended upper normal left atrial volume indexed for body surface area (BSA) is 34 ml/m<sup>2 </sup>for both women and men <sup>1</sup>.</p><h5>MRI</h5><p>Normal values are derived for SSFP cine sequences from the updated publication by Kawel-Boehm <sup>2</sup>. Values above the normal indicate atrial dilatation.</p><h6>Left atrium</h6><p>Simpson’s method (left atrial appendage included) <sup>2,3</sup>:</p><p><strong>Women (adult):</strong></p><ul>
  • +<li>maximum left atrial volume [mL]: 37-94 mL</li>
  • +<li>maximum left atrial volume/BSA [mL/m<sup>2</sup>]: 25-53 mL/m<sup>2</sup>
  • +</li>
  • +</ul><p><strong>Men (adult):</strong></p><ul>
  • +<li>maximum left atrial volume [mL]: 42-115 mL</li>
  • +<li>maximum left atrial volume/BSA [mL/m<sup>2</sup>]: 25-56 mL/m<sup>2</sup>
  • +</li>
  • +</ul><p>Biplane area-length method (left atrial appendage excluded) <sup>2,4</sup>:</p><p><strong>Women (adult):</strong></p><ul>
  • +<li>maximum left atrial volume [mL]: 28-100 mL</li>
  • +<li>maximum left atrial volume/BSA [mL/m<sup>2</sup>]: 17-61 mL/m<sup>2</sup>
  • +</li>
  • +</ul><p><strong>Men (adult):</strong></p><ul>
  • +<li>maximum left atrial volume [mL]: 31-112 mL </li>
  • +<li>maximum left atrial volume/BSA [mL/m<sup>2</sup>]: 17-59 mL/m<sup>2</sup>
  • +</li>
  • +</ul><h6>Right atrium</h6><p>Simpson’s method (right atrial appendage included) <sup>2,3</sup>:</p><p><strong>Women (adult):</strong></p><ul>
  • +<li>maximum right atrial volume [mL]: 49-122 mL</li>
  • +<li>maximum right atrial volume/BSA [mL/m<sup>2</sup>]: 31-69 mL/m<sup>2</sup>
  • +</li>
  • +</ul><p><strong>Men (adult):</strong></p><ul>
  • +<li>maximum right atrial volume [mL]: 59-158 mL </li>
  • +<li>maximum right atrial volume/BSA [mL/m<sup>2</sup>]: 32-79 mL/m<sup>2</sup>
  • +</li>
  • +</ul><p>Biplane area-length method (right atrial appendage excluded) <sup>2,5</sup>:</p><p><strong>Women (adult):</strong></p><ul>
  • +<li>maximum right atrial volume [mL]: 24-81 mL</li>
  • +<li>maximum right atrial volume/BSA [mL/m<sup>2</sup>]: 16-54 mL/m<sup>2</sup>
  • +</li>
  • +</ul><p><strong>Men (adult):</strong></p><ul>
  • +<li>maximum right atrial volume [mL]: 24-105 mL </li>
  • +<li>maximum right atrial volume/BSA [mL/m<sup>2</sup>]: 15-61 mL/m<sup>2</sup>
  • +</li>
  • +</ul>

References changed:

  • 1. Lang R, Badano L, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. <a href="https://doi.org/10.1016/j.echo.2014.10.003">doi:10.1016/j.echo.2014.10.003</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25559473">Pubmed</a>
  • 2. Kawel-Boehm N, Hetzel S, Ambale-Venkatesh B et al. Reference Ranges ("normal Values") for Cardiovascular Magnetic Resonance (CMR) in Adults and Children: 2020 Update. J Cardiovasc Magn Reson. 2020;22(1):87. <a href="https://doi.org/10.1186/s12968-020-00683-3">doi:10.1186/s12968-020-00683-3</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33308262">Pubmed</a>
  • 3. Le Ven F, Bibeau K, De Larochellière É et al. Cardiac Morphology and Function Reference Values Derived from a Large Subset of Healthy Young Caucasian Adults by Magnetic Resonance Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(9):981-90. <a href="https://doi.org/10.1093/ehjci/jev217">doi:10.1093/ehjci/jev217</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26354980">Pubmed</a>
  • 4. Li W, Wan K, Han Y et al. Reference Value of Left and Right Atrial Size and Phasic Function by SSFP CMR at 3.0 T in Healthy Chinese Adults. Sci Rep. 2017;7(1):3196. <a href="https://doi.org/10.1038/s41598-017-03377-6">doi:10.1038/s41598-017-03377-6</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28600567">Pubmed</a>
  • 5. Petersen S, Khanji M, Plein S, Lancellotti P, Bucciarelli-Ducci C. European Association of Cardiovascular Imaging Expert Consensus Paper: A Comprehensive Review of Cardiovascular Magnetic Resonance Normal Values of Cardiac Chamber Size and Aortic Root in Adults and Recommendations for Grading Severity. Eur Heart J Cardiovasc Imaging. 2019;20(12):1321-31. <a href="https://doi.org/10.1093/ehjci/jez232">doi:10.1093/ehjci/jez232</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31544926">Pubmed</a>

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