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Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery
Published on: February 20, 2017
Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?
Teresa S M Tsang1, Walter P Abhayaratna, Marion E Barnes
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. tsang.teresa@mayo.edu
Insights
Left atrial volume is a superior predictor of cardiovascular events in patients with sinus rhythm compared to area or diameter. LA size measurements were not predictive of events in patients with atrial fibrillation.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Risk Stratification
Background:
- The prognostic value of left atrial (LA) volume versus LA area or diameter as a cardiovascular risk marker requires prospective evaluation.
- Previous studies have not definitively compared these left atrial size parameters in patients with sinus rhythm or atrial fibrillation (AF).
Purpose of the Study:
- To compare the predictive capabilities of left atrial (LA) volume, LA area, and LA diameter for adverse cardiovascular outcomes.
- To determine the incremental value of LA volume over LA area or diameter in risk stratification.
Main Methods:
- Prospective assessment of left atrial size using biplane LA volume, four-chamber LA area, and M-mode dimension in 423 patients.
- Follow-up for the incidence of new-onset AF, congestive heart failure, stroke, transient ischemic attack, myocardial infarction, coronary revascularization, and cardiovascular death.
Main Results:
- Left atrial volume demonstrated superior performance in predicting cardiovascular events compared to LA area and diameter (AUC: 0.71 vs. 0.64 vs. 0.59, respectively).
- A graded association between LA enlargement and cardiovascular event risk was observed only for indexed LA volume in patients with sinus rhythm.
- No significant association was found between LA size and cardiovascular events in patients with atrial fibrillation.
Conclusions:
- Left atrial volume is a more robust predictor of cardiovascular events than LA area or diameter in patients with sinus rhythm.
- The predictive value of LA size for cardiovascular events is poor in patients with atrial fibrillation, regardless of measurement method.
Objectives:
We sought to compare left atrial (LA) volume to LA area and diameter for the prediction of adverse cardiovascular outcomes.
Background:
The incremental value of LA volume compared with LA area or diameter as a cardiovascular risk marker has not been evaluated prospectively for patients with sinus rhythm or atrial fibrillation (AF).
Methods:
Left atrial size was assessed with biplane LA volume, four-chamber LA area, and M-mode dimension for 423 patients (mean age 71 +/- 8 years, 56% men) who were prospectively followed for development of first AF, congestive heart failure, stroke, transient ischemic attack, myocardial infarction, coronary revascularization, and cardiovascular death.
Results:
Of the 317 subjects in sinus rhythm at baseline, 62 had 90 new events during a mean follow-up of 3.5 +/- 2.3 years. All three LA size parameters were independently predictive of combined outcomes (all p < 0.0001). The overall performance for the prediction of cardiovascular events was greatest for LA volume (area under the receiver operator characteristic curve: indexed LA volume 0.71; LA area 0.64; LA diameter 0.59). A graded association between the degree of LA enlargement and risk of cardiovascular events was only evident for indexed LA volume. For subjects with AF, there was no association between LA size and cardiovascular events.
Conclusions:
Left atrial volume is a more robust marker of cardiovascular events than LA area or diameter in subjects with sinus rhythm. The predictive utility of LA size for cardiovascular events in AF was poor, irrespective of the method of LA size quantitation.
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