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Aim Appropriate assessment of left atrial (LA) structural remodeling is very important for patients (pts) with atrial fibrillation (AF) and other comorbidities like diastolic dysfunction. Methods We enrolled 170 pts with LA area more than 20 cm2 (defined as structural remodelled atria) with or without antecedents of AF. We used echocardiography by Tissue Doppler Imaging to predict LA geometry and shape changing as asymmetric structural remodeling (ASR) markers. We assessed indexed LA volume evolution depending on asymmetrical shape changing. LA-ASR was defined as basal dimension, at the atrial pulmonary vein junction level, greater than the mitral annular dimension; otherwise LA was considered symmetrical structural remodeled (SSR).Results: Mean BMI was 28±5 kg/cm2, 61% were men. Seventy four of pts were with hypertension, 33% with coronary artery disease and 19% with diabetes mellitus. Fourthy one percent of pts were without history of AF and in stable sinus rhythm (SR) and 59% with nonvalvular AF (14% paroxysmal, 9% persistent and 36% permanent). Mean ventricular frequency was 72±10/min. LA-ASR was detected in 69% of pts: 78% in AF and 62% in stable SR. Mean indexed LA-ASR and LA-SSR volume (assessed by ellipsoid biplane area-length formula) were 49±14 ml/m2 respectively 29±13 ml/m2, and were statistically significant correlated (r=0.567 by Pearson method and r=0.528 by Spearman method, p<0.001). Mean indexed LA volume in pts in SR and AF was 37±10 ml/m2 respectively 44±17 ml/m2 (p<0.001). Mean TDI parameters were statistically significant lower in LA-ASR than in those with LA-SSR (all p<0.05). LA-ASR is associated with L wave (r=0.445, p<0.001), LA S wave (r=0.187, p=0.015), pulmonary vein D wave (r=0.247, p=0.001), E/E' (r=0.218, p=0.004), E/E'xS' (r=0.475, p<0.05) and LA pressure (r=0.216, p=0.005). The highest negative predictive value in LA-ASR exclusion for pts in SR was for LA pressure (expressed by E/E') followed by E/E'xS' (73% respectively 60%).Conclusions: Left atrial asymmetric structural remodeling is associated with a shape change in many cases of dilated atria, irrespective of sinus rhythm or atrial fibrillation presence. Echocardiography by Tissue Doppler Imaging might be an important predictor for detection of left atrium asymmetric structural remodeling and appropriate assessment of left atrial volume.