Measurement of Left Atrial Volume from Transthoracic Three-Dimensional Echocardiographic Datasets Using the Biplane Simpson’s Technique

Iwataki, Mai; Takeuchi, Masaaki; Otani, Kyoko; Kuwaki, Hiroshi; Haruki, Nobuhiko; Yoshitani, Hidetoshi; Tamura, Masahito; Abe, Haruhiko; Otsuji, Yutaka

doi:10.1016/j.echo.2012.08.017

Cited by 52 publications

(50 citation statements)

References 22 publications

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“…The same group reported similar results in another study performed on patients with a wide range of LA sizes. 17 These discrepancies may also be related to the type of software used, endocardial tracing errors, and 2D misalignment of orthogonal apical 4-chamber and apical 2-chamber views. Indeed, it is also possible that some degree of LA foreshortening persisted on the 2D acquisition, despite every attempt made by the operator to avoid it.…”

Section: See Article By Badano Et Almentioning

confidence: 99%

“…Most of the normative LA volume data from these additional studies were derived from subjects who had LA volumes measured from LA-dedicated views and LA volumes measured using the area-length method. [8][9][10][11][12][13][14][15][16][17][18] Just as it is important not to foreshorten the left ventricle when obtaining measurements of LV volumes and ejection fraction, it is just as crucial to not foreshorten the LA (Figure). 19 This important point is well detailed in the current study by Badano et al, 3 which emphasizes that when acquiring images to measure LA volumes on 2D echocardiography, dedicated acquisitions of the LA or focused views need to be acquired.…”

Section: See Article By Badano Et Almentioning

confidence: 99%

“…Similar comparisons have been made in previous studies, and interestingly, the findings have not been uniform. 17,24 Wu et al, for instance, used dedicated LA views to measure 2D LA volumes in their normal population of n=124 patients using the biplane Simpson method. They found no significant differences between 2D and 3D LA volumes.…”

Section: See Article By Badano Et Almentioning

confidence: 99%

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Complexities of Left Atrial Analysis

Addetia

Lang

2016

Circ: Cardiovascular Imaging

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L eft atrial (LA) size is an important marker for the chronicity of elevated left ventricular (LV) filling pressures and a powerful predictor of adverse cardiovascular outcomes, including stroke, development of atrial fibrillation, congestive heart failure, and death.1 Among the different parameters available for assessing LA size, including diameter, area, and volumes, the latter has been shown to be the most accurate and robust predictor of cardiovascular outcomes.2 Accordingly, a significant amount of interest has recently emerged toward establishing the most accurate echocardiographic method to measure LA volumes. In this regard, Badano et al 3 must be commended for completing the first study, published in this issue of Circulation: Cardiovascular Imaging, providing normal reference values for both 2-dimensional (2D) and 3-dimensional (3D) LA volumes together with phasic function indices in a relatively large group of normal subjects over a wide range of ages. As the authors accurately expressed in their article: "availability of reference values…is a prerequisite for routine clinical application." See Article by Badano et alHistorically, LA size was initially assessed using M-mode echocardiography acquired from the parasternal long-axis view. In this transducer position, the antero-posterior dimension of the LA was recorded. Because this measurement is highly reproducible, it was widely adopted by echocardiography laboratories worldwide. It soon became obvious, however, that the LA does not dilate symmetrically in all directions when it enlarges. In fact, there is data to suggest that left atrial enlargement in the antero-posterior direction is constricted by the presence of the spine and sternum, and accordingly, most of the LA enlargement tends to occur in the superior-inferior direction. 4 Because of this, the use of m-mode echocardiography was strongly discouraged in the American Society of Echocardiography 2005 chamber quantification guidelines, and measurements of LA volumes were recommended for clinical practice. Both the 2005 and the current 2015 chamber quantification guidelines recommend the use of the biplane method of discs or the area-length method for the measurement of LA volumes. 5,6 The area-length method has been shown to result in atrial volumes that are slightly larger than those obtained using the biplane method of discs.7 Importantly, there was a major increase in the published values for normal LA volumes between the 2005 and 2015 chamber quantification guidelines. The upper normal reference value increased from 28 mL/m 2 for both men and women in 2005 to 34 mL/m 2 in 2015. 5,6 The main reason for this change is that the 2015 document had access to normative LA volume data obtained from a large number of studies conducted after the 2005 guidelines had been published. Most of the normative LA volume data from these additional studies were derived from subjects who had LA volumes measured from LA-dedicated views and LA volumes measured using the area-length method. [8][9][10][11][12][1...

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Section: See Article By Badano Et Almentioning

confidence: 99%

Section: See Article By Badano Et Almentioning

confidence: 99%

Section: See Article By Badano Et Almentioning

confidence: 99%

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Complexities of Left Atrial Analysis

Addetia

Lang

2016

Circ: Cardiovascular Imaging

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“…The 3D volumetric assessment of the left atrium was performed by the biplane Simpson's method extracted from 3D data sets with commercially available software (3DQ, QLAB, version 9.0; Philips Medical System). 18 Maximal and minimal left atrial volumes were measured and indexed to the body surface area.…”

Section: D Transthoracic Echocardiographymentioning

confidence: 99%

Prognostic Value of Right Ventricular Ejection Fraction Assessed by Transthoracic 3D Echocardiography

Nagata

Kado

et al. 2017

Circ: Cardiovascular Imaging

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R ight ventricular (RV) function is closely coupled with subsequent morbidity and mortality in patients with diseases affecting the right heart chambers. [1][2][3][4][5][6][7] The most common cause of RV dysfunction is chronic left-sided heart failure. Complex factors such as pulmonary hypertension, intrinsic myocardial involvement, ventricular interdependence, and myocardial ischemia lead to RV dysfunction. 1 Therefore, assessment of RV function is clinically important in almost all patients with heart disease. However, the complex geometry of the RV poses a significant limitation to the reliable quantitation of RV volumes and ejection fraction (RVEF) using 2-dimensional transthoracic echocardiography. Although cardiac magnetic resonance (CMR) imaging is the gold standard for the evaluation of RV volumes and RVEF, 8,9 factors such as cost, portability, time consumption, and contraindications hinder its routine use in every patient. Three-dimensional transthoracic echocardiography (3DTTE) has the advantage of full-volume acquisition of the entire right ventricle, which may overcome the technical and clinical limitations of 2-dimensional transthoracic echocardiography. [10][11][12] Recent studies have validated the accuracy of 3DTTE-determined RV volumes and RVEF against CMR 13,14 and determined the reference values of RV volumes and RVEF in healthy subjects. 15,16 However, the prognostic value of RVEF is largely unknown. We hypothesized that RVEF assessed by 3DTTE (3DRVEF) would offer incremental value over left ventricular (LV) functional parameters for predicting future cardiac events. See Editorial by Fernández-Golfín and Zamorano See Clinical PerspectiveAccordingly, the aims of this study were (1) to validate the accuracy of 3DTTE-determined RV volumes and RVEF against CMR reference and (2) to evaluate the prognostic value of 3DRVEF to predict future cardiac death and major adverse cardiac events (MACEs) in a large number of patients.Background-Cardiac magnetic resonance is the gold standard for the evaluation of right ventricular (RV) volumes, but it is impractical to perform in every patient. Although reference values of RV volumes and RV ejection fraction by 3D transthoracic echocardiography (3DTTE) have been established, their prognostic values have not been elucidated yet. We hypothesized that RV ejection fraction measured by 3DTTE (3DRVEF) predicts future cardiovascular events. Methods and Results-In protocol 1, we determined the accuracy of RV volumes and RV ejection fraction measurements by 3DTTE against cardiac magnetic resonance in 60 subjects. In protocol 2, 3DRVEF was measured in 446 patients with various cardiovascular diseases. Study subjects were followed up to record cardiac death and major adverse cardiovascular events. In protocol 1, 3DTTE-determined RV end-diastolic volume, end-systolic volume, and RV ejection fraction had good correlations to those by cardiac magnetic resonance (r=0.74-0.90). In protocol 2, 38 cardiac deaths and 88 major adverse cardiovascular events occurred during a med...

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“…In addition, the LA is characterized by a complex structure, and the LA volume measurement in this study was methodologically limited due to calculations using geometric assumptions. Three-dimensional echocardiography has the potential to depict LA structure more accurately than the two-dimensional echocardiography as previously reported (13,18). However, the three-dimensional approach is limited in terms of time resolution, and this limits the analysis of the time-varying pressure-volume or pressure-strain loops.…”

Section: Study Limitationsmentioning

confidence: 99%

Compensatory increase of left atrial external work to left ventricular dysfunction caused by afterload increase

Inoue

Asanuma

Masuda

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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Inoue K, Asanuma T, Masuda K, Sakurai D, Higaki J, Nakatani S. Compensatory increase of left atrial external work to left ventricular dysfunction caused by afterload increase. Am J Physiol Heart Circ Physiol 308: H904 -H912, 2015. First published January 30, 2015 doi:10.1152/ajpheart.00530.2014.-Afterload mismatch can cause acute decompensation leading to an occurrence of acute heart failure. We investigated how the left atrium (LA) and left ventricle (LV) react to acute increases in afterload using speckle tracking echocardiography (STE). LA strain and volume were obtained by STE in 10 dogs during banding of descending aorta (AoB). Simultaneously, LA pressure was measured by a micromanometer-tipped catheter. LA peak negative strain during LA contraction, strain change during LA relaxation (early reservoir strain), and that during LA dilatation (late reservoir strain) were obtained from LA longitudinal strain-volume curves. From pressure-strain curves, the areas of A-loop and V-loops were computed as the work during active contraction and relaxation (A-work) and that during passive filling and emptying (V-work). AoB increased LV systolic pressure (105 Ϯ 15 vs. 163 Ϯ 12 mmHg, P Ͻ 0.01) and mean LA pressure (3.8 Ϯ 1.2 vs. 7.1 Ϯ 2.0 mmHg, P Ͻ 0.01). LV global circumferential strain decreased (Ϫ18.8 Ϯ 3.5 vs. Ϫ13.2 Ϯ 3.5%, P Ͻ 0.01), but LV stroke volume was maintained (8.4 Ϯ 2.3 vs. 9.6 Ϯ 3.6 ml). LA peak negative strain (Ϫ2.9 Ϯ 2.3 vs. Ϫ9.8 Ϯ 4.0%, P Ͻ 0.01) and early reservoir strain (4.5 Ϯ 2.1 vs. 7.7 Ϯ 2.4%, P Ͻ 0.05) increased by AoB, but late reservoir strain did not change (8.9 Ϯ 3.4 vs. 6.1 Ϯ 3.4%). A-work significantly increased (3.2 Ϯ 2.0 vs. 19.2 Ϯ 15.1 mmHg %, P Ͻ 0.01), whereas V-work did not change (13.3 Ϯ 7.1 vs. 13.1 Ϯ 7.7 mmHg %). In conclusion, LA external work during active contraction and relaxation increased as compensation for LV dysfunction during aortic banding. Atrial dysfunction may lead failure of this mechanism and hemodynamic decompensation. atrial function; speckle tracking echocardiography; external work ACUTE HEART FAILURE IS A MAJOR cause of hospitalizations and is associated with significant mortality (8, 9). The process of transition from asymptomatic to overt heart failure is complex and incompletely understood. Increased afterload is one of the key triggers for the sudden onset of life-threatening pulmonary edema. An acute increase of blood pressure results in a preload recruitment to maintain left ventricular (LV) stroke volume according to the Frank-Starling mechanism (21), and the left atrium (LA) immediately reacts to the hemodynamic overload by enhancing LA contraction and relaxation. Accordingly, the failure of LA adaptation leads to a decompensated state of heart failure (15).Echocardiography plays an important role in the assessment of LA structure and function. In an experimental study, Barbier et al.(1) measured LA reservoir function by calculating the expansion rate of the LA area with automated border detection echocardiography. That study identified the determinant...

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Measurement of Left Atrial Volume from Transthoracic Three-Dimensional Echocardiographic Datasets Using the Biplane Simpson’s Technique

Cited by 52 publications

References 22 publications

Complexities of Left Atrial Analysis

Complexities of Left Atrial Analysis

Prognostic Value of Right Ventricular Ejection Fraction Assessed by Transthoracic 3D Echocardiography

Compensatory increase of left atrial external work to left ventricular dysfunction caused by afterload increase

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