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The aim of this study was to investigate and to examine the relation between LAV indexed to height<jats:sup>2<\/jats:sup> and left atrial function in patients with moderate to severe obesity. Echocardiograms of patients with moderate to severe obesity (body mass index (BMI)\u2009\u2265\u200935 kg\/m<jats:sup>2<\/jats:sup>) without known cardiac disease were analyzed. LAV was indexed to body surface area (BSA) and height<jats:sup>2<\/jats:sup>, and patients were divided into those with or without left atrial enlargement (LAE) based on normalization using either BSA (LAE<jats:sub>bsa<\/jats:sub>) or height<jats:sup>2<\/jats:sup> (LAE<jats:sub>h2<\/jats:sub>). 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\u2009&lt;\u200914%. A total of 142 patients were included in the analysis of whom 54.2% had LAE<jats:sub>h2<\/jats:sub> and 18.3% LAE<jats:sub>BSA<\/jats:sub>. The LAE<jats:sub>h2<\/jats:sub> group had significantly lower LASct (12.2%\u2009\u00b1\u20093.2% vs. 13.6%\u2009\u00b1\u20094.5%, p\u2009=\u20090.019) as compared to the patients without LAE<jats:sub>h2<\/jats:sub>. Significantly more patients with LA dysfunction would be correctly identified by LAE<jats:sub>h2<\/jats:sub> than by LAE<jats:sub>BSA<\/jats:sub> (41.5% vs. 15.0%, p\u2009&lt;\u20090.001). In patients with moderate to severe obesity, the use of LAE<jats:sub>h2<\/jats:sub> identified significantly more patients with decreased LA function. LAV<jats:sub>h2<\/jats:sub> should be preferred over LAV<jats:sub>BSA<\/jats:sub> in patients with moderate to severe obesity.<\/jats:p>","DOI":"10.1007\/s10554-023-02981-0","type":"journal-article","created":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T08:02:19Z","timestamp":1698307339000},"page":"65-72","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Improved identification of left atrial enlargement in patients with obesity"],"prefix":"10.1007","volume":"40","author":[{"given":"Yaar","family":"Aga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalin","family":"Acardag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie Fen","family":"Chin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daan","family":"Kroon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne Marjolein","family":"Snelder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lotte","family":"De Groot-De Laat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulas","family":"Biter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Zijlstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper","family":"Brugts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"van Dalen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,26]]},"reference":[{"issue":"36","key":"2981_CR1","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","volume":"42","author":"TA McDonagh","year":"2021","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M et al (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. 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