Prognostic Value of LA Volumes Assessed by Transthoracic 3D Echocardiography

Wu, Victor Chien‐Chia; Takeuchi, Masaaki; Kuwaki, Hiroshi; Iwataki, Mai; Nagata, Yasufumi; Otani, Kyoko; Haruki, Nobuhiko; Yoshitani, Hidetoshi; Tamura, Masahito; Abe, Haruhiko; Negishi, Kazuaki; Lin, Fen-Chiung; Otsuji, Yutaka

doi:10.1016/j.jcmg.2013.08.002

Cited by 93 publications

(70 citation statements)

References 28 publications

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“…Currently, only 2 additional small studies report on normal values for 3D LA volumes. 22,23 Aune et al evaluated a population of white Europeans and reported an upper limit for LA volumes of 41 mL/m 2 , which is similar to the upper limit published by Badano et al Wu et al, on the contrary, studied a population of Asian subjects and reported lower upper limits of 33 mL/m 2 for 3D LA volume. This discrepancy likely highlights the differences in normal values that exist between ethnicities.…”

Section: See Article By Badano Et Alsupporting

confidence: 64%

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 Alsupporting

confidence: 64%

Complexities of Left Atrial Analysis

Addetia

Lang

2016

Circ: Cardiovascular Imaging

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“…Aune et al 10 studied . Interestingly, in their study, Wu et al 8 did not found any difference between 2DE and 3DE LA volumes, and their 3DE normal limit for Vmax is actually smaller than the 2DE one (33 versus 36 mL). This is in contrast with all the other studies that have compared 2DE versus 3DE LA volumes and reported a 20% underestimation of LA volumes by 2DE in comparison to computed tomography and CMR.…”

Section: Reference Values For La Volumesmentioning

confidence: 71%

“…Moreover, 3DE LA volume offers an incremental capability to predict cardiovascular events compared with 2DE. 8,9 Thus, 3DE has the potential to become the primary technique to assess LA size and function in clinical practice, pending the availability of robust reference values. At present, reference data of 3DE LA volumes and phasic function are limited.…”

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confidence: 99%

Left Atrial Volumes and Function by Three-Dimensional Echocardiography

Badano

Miglioranza

Mihaila

et al. 2016

Circ: Cardiovascular Imaging

143

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Because 3-dimensional echocardiography (3DE) does not imply any geometric assumption, it provides a more accurate 5,6 and reproducible 7 measurement of LA volumes than 2DE. Moreover, 3DE LA volume offers an incremental capability to predict cardiovascular events compared with 2DE. 8,9 Thus, 3DE has the potential to become the primary technique to assess LA size and function in clinical practice, pending the availability of robust reference values. At present, reference data of 3DE LA volumes and phasic function are limited. 2,10Accordingly, we designed this study to (1) ; 53 versus 48%, respectively; P<0.001). 3DE LA volumes indexed by body surface area were similar in men and women and increased with age. On multivariable analysis, age, weight, and left ventricular systolic and diastolic function indices resulted as correlates of LA 3DE indices. LA volumes were tightly correlated with cardiac magnetic resonance measurements, yet more underestimated by 2DE versus 3DE (bias±SD: −17±16 versus −7±15 mL, respectively). Among all LA parameters, maximal LA volume and total emptying fraction were the most reproducible, including at test-retest and at expert versus trainee comparisons. Conclusions-This study provides reference values for LA 3DE volumes and function from a relatively large cohort of healthy subjects with a wide age range. Our data may help clinicians to identify LA remodeling and dysfunction.(Circ Cardiovasc Imaging. 2016;9:e004229.

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“…2 LA mechanics has been proved as an important independent predictor of the outcome in patients with atrial fibrillation, heart failure, myocardial infarction, or valve heart disease. 3 Similarly to the LA, the right atrium (RA) mirrors the diastolic filling pressure of the right ventricle (RV).…”

Section: Introductionmentioning

confidence: 99%