Atrial diameter predicts mortality

Michael Stylidis has followed Tromsø Study participants for 23 years to study the long-term risk of all-cause mortality using echocardiography indices of diastolic dysfunction.


  1. Several markers of diastolic dysfunction show U-shaped associations with all-cause mortality.
  2. Global longitudinal strain is a sensitive predictor of early, subclinical heart failure.
  3. Abnormal lung sounds could predict heart failure.


Thesis: Clinical characteristics, echocardiographic indices of heart failure and mortality in a general population
Candidate: Michael Stylidis
Time: August 21, 2020 at 12:15
Place: Online-based solution, due to the covid-19 situation
Link to university website (in Norwegian)


(1) Both small and large atrial diameters are associated with increased risk of all-cause mortality. Moreover, mitral peak E deceleration time and mitral peak E to peak A ratio also show U-shaped associations with all-cause death. Prognostic accuracy improves when combining measurements of left atrial diameter and mitral peak E deceleration time.

2734 men and women from the general population had echocardiography as a part of the Tromsø 4 Study in 1994 or 1995. Two thirds of them had another measurements in Tromsø 5 or 6 up to 13 years later. 1399 participants died before 2016.

(2) Global longitudinal strain is lower in persons with subclinial heart failure than others. Higher systolic blood pressure also associates with a reduction in global longitudinal strain.

1855 participants from the Tromsø 7 Study in 2015 and 2016 were included in the study. Mean global longitudinal strain in was − 15.9% in healthy men and −17.8% in healthy women. It declined with age.

(3) Basal bilateral inspiratory crackles are common in patients with established heart failure, whereas COPD could be predicted by wheezes, according the Stylidis’ third paper. Elevated proBNP is an independent predictor of heart failure. Almost one tenth of patients with heart failure have co-existing COPD.


(1) Stylidis, M., Sharashova, E., Wilsgaard, T., Leon, D. A., Heggelund, G., Rösner, A.,  & Schirmer, H. (2019). Left atrial diameter, left ventricle filling indices, and association with all‐cause mortality: Results from the population‐based Tromsø Study. Echocardiography36(3), 439-450.

(2) Stylidis, M., Leon, D. A., Rӧsner, A., & Schirmer, H. (2020). Global myocardial longitudinal strain in a general population—associations with blood pressure and subclinical heart failure: The Tromsø StudyThe International Journal of Cardiovascular Imaging36(3), 459-470.

(3) Melbye, H., Stylidis, M., Aviles-Solis, J.C., Averina, M. & Schirmer, H. Prediction of chronic heart failure and COPD in a general population. The Tromsø Study.

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