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Predictive value of normal left atrial volume in stress echocardiography
Ahmed A Alsaileek1, Martin Osranek, Kaniz Fatema
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
A normal left atrial volume index (LAVI) strongly predicts a normal stress echocardiogram, indicating low ischemic risk. This simple measurement can help identify patients with reduced likelihood of coronary artery disease.
Area of Science:
- Cardiology
- Echocardiography
- Ischemic Heart Disease
Background:
- Left atrial enlargement correlates with increased ventricular filling pressure and the burden of ischemic heart disease (IHD).
- Increased filling pressure, indicated by left atrial volume index (LAVI), may reflect subclinical and overt IHD.
- A normal LAVI could potentially predict a low risk of IHD.
Purpose of the Study:
- To determine if a normal left atrial volume index (LAVI) predicts a normal stress echocardiogram.
- To assess if a normal LAVI is a predictor of low ischemic risk.
Main Methods:
- 180 patients underwent stress echocardiography for suspected coronary artery disease.
- Left atrial volume index (LAVI) was measured retrospectively using the biplane area-length method.
- Stress echocardiograms were classified as abnormal if resting or stress-induced wall motion abnormalities were present.
Main Results:
- Abnormal stress echocardiograms were found in 31.7% of patients.
- The percentage of abnormal stress echocardiograms increased with LAVI categories.
- A normal LAVI (<=28 ml/m2) had a negative predictive value of 94.3% for a normal stress echocardiogram.
Conclusions:
- A normal resting left atrial volume index (LAVI) is a strong predictor of a normal stress echocardiogram.
- LAVI may serve as a simple tool for identifying patients at low ischemic risk.
- Further evaluation of LAVI as a complementary tool for ischemic risk assessment is warranted.
Objectives:
Our objective was to evaluate whether normal left atrial volume index (LAVI) is a predictor of a normal stress echocardiogram and thus a predictor of low ischemic risk.
Background:
Left atrial enlargement is closely related to the chronicity and intensity of the burden of increased ventricular filling pressure. Typically ischemic heart disease (IHD) has a long period of subclinical dysfunction. Increased filling pressure, reflected by enlarged LAVI, is hypothesized to mirror the burden of subclinical and overt IHD. We hypothesized that a normal LAVI might also be useful in predicting low IHD risk.
Methods:
One hundred eighty randomly selected patients (mean age, 63 +/- 15 years; 53% men) underwent outpatient exercise or dobutamine stress echocardiography for known or suspected coronary artery disease. Left atrial volume index was measured retrospectively with the biplane area-length method. The stress echocardiogram was interpreted as abnormal if wall motion abnormalities (WMAs) were noted at rest and/or with stress.
Results:
Left atrial volume index was categorized as < or =28 ml/m2 (normal), 28.1 to 32 ml/m2, 32.1 to 36 ml/m2, and >36 ml/m2. Abnormal stress echocardiography was identified in 57 patients (31.7%). The percentage of abnormal stress echocardiograms in each LAVI category was 5.7%, 21.9%, 38.7%, and 54.7%, respectively. The negative predictive value for LAVI < or =28 ml/m2 was 94.3%.
Conclusions:
Normal resting LAVI (< or =28 ml/m2) was strongly predictive of a normal stress echocardiogram. Left atrial volume index might be a simple means of identifying patients with low ischemic risk and should be further evaluated as a complement to the assessment of ischemic risk.
