Although the measurement of left atrial diameter (LAD) is a standard part of any echocardiographic examination, the normal range for adults has never been well established or correlated with body surface area (BSA) and sex. We studied 100 males and 100 females whose ages ranged from 15 to 70 years, with no evidence of mitral value disease or other form of heart disease which might cause left atrial enlargement. All measurements were obtained between the external surface of posterior aortic root (AR) and the internal surface of the left atrial wall and were recorded at ventricular end diastole (ED) as well as end systole (ES). The LAD at ED ranged from 9.5 to 29.5 mm with a mean of 19 mm +/- 5.0 S.D.; the diameter at ES ranged from 18.3 mm to 38.7 mm with a mean of 28.5 mm +/- 5.1 S.D. The mean LAD at ED was 20.7 mm +/- 4.8 S.D. in makes compared to the mean diameter of 18.3 +/- 4.9 S.D. in females which represents a significant difference (p less than 0.001). The LAD did not correlate with BSA. The left atrial dimension by ultrasound in these 200 normal patients was compared with the same measurement in 50 catheterized patients with mitral valve disease and proven left atrial enlargement. When absolute values of the left atrial dimension both at end systole and end diastole were determined by ultrasound, there was a clear separation between normal and abnormal (p less than 0.001).
Introduction Echocardiographic screening can detect rheumatic heart disease (RHD) in high-risk populations,but is limited by reliance on highly-trained experts and equipment. We sought to determine the diagnostic utility of an ultra-abbreviated single parasternal-long-axis-sweep of the heart (SPLASH) echocardiography protocol to detect RHD, performed by briefly-trained health workers. Methods In Timor-Leste and Northern Australia, individuals aged 5–20y were offered school-based echocardiographic screening. Health workers completed online modules followed by one-week of practical training, logging 50 echocardiograms prior to study. The index test was SPLASH, performed and reported by health workers using handheld GE V-scan devices. The index test was abnormal if any mitral or aortic regurgitation was detected. The reference test was a comprehensive echocardiogram, performed by an echocardiographers or cardiologist on a GE Vivid-Q, reported according to World Heart Federation criteria. The diagnostic accuracy of the index test was determined. Results 2590 subjects underwent index and reference tests. Prevalence of definite RHD was 3.2% (83/2590). Sensitivity and specificity of index test were 0.75 (95% CI 0.64–0.83) and 0.77 (95% CI 0.75–0.78) respectively for detection of any definite RHD, and 0.91 (95% CI 0.74–0.98) and 0.76 (95% CI 0.74–0.78) respectively for detection of moderate or severe RHD. Conclusion Health workers using SPLASH detected the vast majority of moderate and severe RHD cases, but lacked sensitivity for detection of mild RHD. Further analysis is underway to evaluate the learning curve and other performance indicators of health workers performing and interpreting echocardiograms. This will allow refinement of SPLASH protocol and augmentation of health worker training to increase detection rates and accuracy for future population screening initiatives. Acknowledgement/Funding Heart Foundation Australia Vanguard Grant, Menzies HOT-NORTH pilot project grant, Snow Foundation, Rotary, Bawinanga Aboriginal Corporation, Mala'la
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