{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:59:04Z","timestamp":1790618344145,"version":"4.1.0"},"reference-count":25,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Left ventricular diastolic dysfunction (LVDD) is associated with chronically elevated left ventricular filling pressures that promote left atrial (LA) remodeling and increase the risk of atrial fibrillation (AF). Because AF is frequently asymptomatic during its early stages, identifying echocardiographic markers that facilitate early risk stratification is of considerable clinical importance. This study investigated the association between LA enlargement and AF in elderly patients with LVDD using conventional echocardiographic LA size parameters. Methods: This prospective observational study enrolled 100 consecutive patients aged \u2265 60 years with echocardiographically confirmed LVDD and no documented history of AF between December 2023 and May 2024. Comprehensive transthoracic echocardiography was performed to assess LA diameter, biplane LA volume using Simpson\u2019s method, LA volume by the area\u2013length method, and indexed LA volume (LAVI). The presence of AF was determined by standard 12-lead electrocardiography and rhythm assessment. Echocardiographic parameters were compared between patients with and without AF using appropriate statistical analyses. Results: The study population had a mean age of 68.37 \u00b1 6.31 years, and 52% were male. AF was identified in 15% of participants, while mild LA enlargement was observed in 18%. Among patients with LA enlargement, 72.2% had AF compared with only 2.4% of patients with a normal LA size (p &lt; 0.001). Patients with AF demonstrated significantly greater biplane LA volume (69.10 \u00b1 9.61 vs. 52.21 \u00b1 6.28 mL), LA volume measured by the area\u2013length method (71.42 \u00b1 9.51 vs. 54.03 \u00b1 6.53 mL), and indexed LA volume (37.33 \u00b1 3.81 vs. 28.87 \u00b1 3.65 mL\/m2) than those without AF (all p &lt; 0.001). Conclusions: Left atrial enlargement measured using echocardiographic assessment, particularly indexed LA volume, is strongly associated with atrial fibrillation in elderly patients with left ventricular diastolic dysfunction.<\/jats:p>","DOI":"10.3390\/jcm15197480","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:36:34Z","timestamp":1790346994000},"page":"7480","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Left Atrial Enlargement and Atrial Fibrillation in Elderly Patients with Left Ventricular Diastolic Dysfunction"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3535-4023","authenticated-orcid":false,"given":"Ameen Abdulhasan","family":"Al-Alwany","sequence":"first","affiliation":[{"name":"College of Medicine, University of Baghdad, Baghdad 10047, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"given":"Faris","family":"Kadhim","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Baghdad, Baghdad 10047, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Mohammed Imad","family":"Salim","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Baghdad, Baghdad 10047, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"given":"Mustafa","family":"Majid","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Baghdad, Baghdad 10047, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4697-9434","authenticated-orcid":false,"given":"Haitham","family":"Nabeel","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Baghdad, Baghdad 10047, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3704-9521","authenticated-orcid":false,"given":"Umniah","family":"Khajori","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Baghdad, Baghdad 10047, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5228-3733","authenticated-orcid":false,"given":"Matteo Luigi Giuseppe","family":"Leoni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Roma, 00135 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developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1161\/CIRCULATIONAHA.113.005119","article-title":"Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 Study","volume":"129","author":"Chugh","year":"2014","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1161\/01.CIR.0000140263.20897.42","article-title":"Lifetime risk for development of atrial fibrillation: The Framingham Heart Study","volume":"110","author":"Wang","year":"2004","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/j.jacc.2019.01.059","article-title":"Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art Review","volume":"73","author":"Thomas","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Hadid, S., El Hajj, M., Hadid, B., Siddiqui, Z., Wang, A., Frishman, W.H., and Aronow, W.S. (Cardiol. Rev., 2024). Diastolic dysfunction and atrial fibrillation: Recognition, interplay, and management, Cardiol. Rev., advance online publication.","DOI":"10.1097\/CRD.0000000000000724"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1161\/CIRCRESAHA.117.309732","article-title":"Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes","volume":"120","author":"Staerk","year":"2017","journal-title":"Circ. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"29","author":"Nagueh","year":"2016","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Carpenito, M., Fanti, D., Mega, S., Benfari, G., Bono, M.C., Rossi, A., Ribichini, F.L., and Grigioni, F. (2021). The central role of the left atrium in heart failure. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.704762"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101675","DOI":"10.1016\/j.disamonth.2024.101675","article-title":"Study the relationship between left atrial (LA) volume and left ventricular (LV) diastolic dysfunction and LV hypertrophy: Correlate LA volume with cardiovascular risk factors","volume":"70","author":"Pawar","year":"2024","journal-title":"Dis. Mon."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bossard, M., Kreuzmann, R., Hochgruber, T., Krisai, P., Zimmermann, A.J., Aeschbacher, S., Pumpol, K., Kessel-Schaefer, A., Stephan, F.P., and Handschin, N. (2016). Determinants of left atrial volume in patients with atrial fibrillation. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0164145"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e003754","DOI":"10.1161\/CIRCIMAGING.115.003754","article-title":"Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: Importance of left atrial strain","volume":"9","author":"Freed","year":"2016","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Alonso, A., Kraus, J., Ebert, A., Nikolayenko, V., Kruska, M., Sandikci, V., Lesch, H., Duerschmied, D., Platten, M., and Baumann, S. (2023). Left atrial area index provides the best prediction of atrial fibrillation in ischemic stroke patients: Results from the LAETITIA observational study. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1237550"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"von Elm, E., Altman, D.G., Egger, M., Pocock, S.J., G\u00f8tzsche, P.C., and Vandenbroucke, J.P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. PLoS Med., 4.","DOI":"10.1371\/journal.pmed.0040296"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_15","unstructured":"Heartcare Sydney (2026, September 07). Left Atrial Size & LAVI\u2014Measurement, Normal Values & Grading. Updated. Available online: https:\/\/heartcare.sydney\/echo-reference\/left-atrial-size\/."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10741-015-9520-9","article-title":"Left atrial strain: A new parameter for assessment of left ventricular filling pressure","volume":"21","author":"Cameli","year":"2016","journal-title":"Heart Fail. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e275","DOI":"10.1016\/j.hrthm.2017.05.012","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation","volume":"14","author":"Calkins","year":"2017","journal-title":"Heart Rhythm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5061","DOI":"10.1093\/eurheartj\/ehad747","article-title":"Beyond the rhythm: Atrial fibrillation, diastolic dysfunction, and heart failure","volume":"44","author":"Inciardi","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/S0002-9149(02)02864-3","article-title":"Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden","volume":"90","author":"Tsang","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1136\/heartjnl-2015-307438","article-title":"Association between diastolic dysfunction and future atrial fibrillation in the Troms\u00f8 Study from 1994 to 2010","volume":"101","author":"Tiwari","year":"2015","journal-title":"Heart"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"467","DOI":"10.4065\/76.5.467","article-title":"Left atrial volume: Important risk marker of incident atrial fibrillation in 1655 older men and women","volume":"76","author":"Tsang","year":"2001","journal-title":"Mayo Clin. Proc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"100487","DOI":"10.1016\/j.clinsp.2024.100487","article-title":"Clinical value of artificial intelligence 3D echocardiography in evaluating left atrial volume and pulmonary vein structure in patients with atrial fibrillation","volume":"79","author":"Yang","year":"2024","journal-title":"Clinics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101299","DOI":"10.1016\/j.jacadv.2024.101299","article-title":"New Frontiers for Predicting Atrial Fibrillation and Stroke: AI-Based Left Atrial Volumetry","volume":"3","author":"Onnis","year":"2024","journal-title":"JACC Adv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4304","DOI":"10.1038\/s41467-024-48229-w","article-title":"Deep learning of left atrial structure and function provides link to atrial fibrillation risk","volume":"15","author":"Pirruccello","year":"2024","journal-title":"Nat. Commun."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7480\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:14:24Z","timestamp":1790615664000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":25,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197480"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197480","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]}}}