Left Atrial Volumes and Phasic Function in Healthy Children: Reference Values Using Real-Time Three-Dimensional Echocardiography

Abstract

Background: Evaluation of left atrial (LA) size and function is important in congenital and acquired pediatric cardiac disease. Real-time three-dimensional echocardiography (3DE) offers noninvasive assessment of cardiac volumes and phasic function independent of geometric assumptions. The aim of this prospective multicenter study was to establish pediatric reference values for LA 3DE volumes and phasic function based on a large cohort of healthy children. Methods: LA data sets of 432 subjects (0 days-222 months) were analyzed prospectively using a vendorindependent software. LA volumes (maximal [Vmax], minimal [Vmin], and before atrial contraction) as well as phasic function (active and passive emptying fraction [EF]) were assessed. For volumes, sex-specific reference values, percentiles, and z-scores were calculated by the LMS method of Cole and Green. Results: Absolute volumes increased with age and body surface area. Active EF and relative duration of atrial emptying tended to increase with increasing R-R intervals, while passive EF decreased. Reproducibility of volumes was very good (intra-and interobserver variability for Vmax and Vmin (mean bias 6 SD, 0.1 6 0.9 mL and 0.7 6 2.8 mL). Volumes were well correlated with cardiac magnetic resonance measurements showing known underestimation of volumes by 3DE (mean bias 6 SD, Vmax-14.2 6 14 mL; Vmin-11.5 6 10 mL). Conclusions: Pediatric LA volumes and phasic function indices were reproducibly measured by 3DE. The provided pediatric reference values can be the basis for evaluation of the LA by 3DE and contribute to detection of LA dysfunction and follow-up of patients with congenital heart diseases.

Real time three‐dimensional echocardiographic quantification of left atrial volume in orthotopic heart transplant recipients: Comparisons with cardiac magnetic resonance imaging

“…The marker for the apex was set at the roof of the LA, and the three‐dimensional (3D) dataset was rotated 60° counterclockwise according to the recommendations of the software developer. This way the shape of the LA better resembled the respective shape of the LV in the three apical views, facilitating automated border detection and tracing 9 . Care was taken to ensure that the entire left atrium was included within a pyramidal 3D dataset.…”

“…But 2DE is subject to errors due to poor endocardial definition, narrow echocardiographic windows, and assumptions about LA shape foreshortening 6,7 . As shown in adults and children who have not undergone cardiac surgery, real time three‐dimensional echocardiography (RT‐3DE) offers an assessment of LAV independent of geometric assumptions and correlates better with CMR 8,9 . Nevertheless, no study confirms whether the criteria can be applied to assess the LAV of heart transplant patients.…”

Comparing a knowledge‐based 3D reconstruction algorithm to TomTec 3D echocardiogram algorithm in measuring left cardiac chamber volumes in the pediatric population

“…[1][2][3][4][5] Three-dimensional volumetric echocardiography (3DE) is an emerging alternative to two-dimensional echocardiography (2DE) which makes fewer geometric assumptions regarding chamber shapes and may provide benefits in accuracy and reproducibility compared to 2DE. [6][7][8] It is therefore important to establish that commercially available algorithms for 3D measurement of cardiac chambers produce comparable results. Both TomTec 4D LV-Analysis software and Philips QLAB LV 3D underestimate LV volumes compared to MRI and have relatively wide inter-vendor limits of agreement in neonates and infants.…”

“…Accurate and reproducible measurements of cardiac chambers are a vital component of diagnosis, prognostication, medical management, and surgical referral in congenital as well as acquired heart diseases in children 1–5 . Three‐dimensional volumetric echocardiography (3DE) is an emerging alternative to two‐dimensional echocardiography (2DE) which makes fewer geometric assumptions regarding chamber shapes and may provide benefits in accuracy and reproducibility compared to 2DE 6–8 …”

Incremental value of three-dimensional echocardiography for evaluating left atrial function in patients with coronary slow flow phenomenon: a case control study

“…However, the measured value of 2DE may be affected by the significant geometric assumptions that exist about LA nonsymmetrical shape or foreshortening of LA cavity in the apical views. Real-time three-dimensional echocardiography (RT3DE) is a useful tool for assessing LA volume and function, with good feasibility and reproducibility, and it has been reported that the LA measurements by RT3DE are more strongly associated with cardiac magnetic resonance imaging than those by 2DE [10,11].…”