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Published on: February 8, 2022
Left atrial volume measured by real-time 3-dimensional echocardiography predicts clinical outcomes in patients with
Il-Woo Suh1, Jong-Min Song, Eun-Young Lee
1Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Insights
Real-time 3-dimensional echocardiography (3D echo) of left atrial volume (LAV-3D) predicts clinical events in patients with severe left ventricular dysfunction. LAV-3D is superior to 2D echocardiography for assessing risk and guiding management.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Imaging
Background:
- The clinical utility of real-time 3-dimensional echocardiography (3D echo) for assessing left atrial volume (LAV) in patients with left ventricular dysfunction remains unclear.
- Left ventricular dysfunction is a significant clinical concern, necessitating accurate prognostic markers.
Purpose of the Study:
- To determine the clinical value of real-time 3-dimensional echocardiography assessments of left atrial volume (LAV-3D) in patients with severe left ventricular dysfunction.
- To compare the prognostic capability of LAV-3D with traditional 2-dimensional echocardiography (LAV-2D).
Main Methods:
- 108 patients with severe left ventricular dysfunction in sinus rhythm underwent same-day real-time 3-dimensional echocardiography and 2-dimensional Doppler echocardiography.
- End-systolic left atrial volumes were measured using 3D echo (LAV-3D) and calculated via the biplane area-length formula from 2D echo (LAV-2D).
- Clinical follow-up was conducted over a mean of 10 months to assess for cardiac events.
Main Results:
- LAV-3D showed excellent correlation with LAV-2D (r=0.88), but LAV-2D measurements were significantly smaller.
- Patients experiencing clinical events (3 cardiac deaths, 28 heart failure hospitalizations) had larger initial LAV-3D and LAV-2D, higher E/E' ratio, and more severe valvular regurgitation.
- LAV-3D emerged as an independent predictor of cardiac events (P < .001), outperforming LAV-2D.
Conclusions:
- Real-time 3-dimensional echocardiography-derived left atrial volume (LAV-3D) is a significant predictor of clinical events in patients with severe left ventricular dysfunction and sinus rhythm.
- LAV-3D demonstrates superior clinical value compared to LAV-2D in this patient cohort, offering enhanced risk stratification.
Background:
The clinical value of real-time 3-dimensional echocardiography assessments of left atrial volume in patients with left ventricular dysfunction has not been determined.
Methods:
Real-time 3-dimensional echocardiography and 2-dimensional Doppler echocardiography were performed on the same day in 108 patients with severe left ventricular dysfunction and in sinus rhythm. End-systolic left atrial volumes were measured using real-time 3-dimensional echocardiography images (LAV-3D) and end-systolic left atrial volumes were calculated by the biplane area-length formula using 2-dimensional echocardiography (LAV-2D). Patients were observed clinically over 10 +/- 7 months.
Results:
LAV-2D showed excellent correlation with LAV-3D (r = 0.88, P < .001), but the former was significantly smaller than the latter (-12 +/- 21 mL, P < .001). During follow-up, 31 patients (29%) showed clinical events, including 3 cardiac deaths and 28 hospitalizations as a result of heart failure. Patients with clinical events had larger initial LAV-3D (P < .05) and LAV-2D (P = .05), higher transmitral E velocity, higher E/E' ratio, more severe mitral and tricuspid regurgitation, and higher maximal velocity of tricuspid regurgitation than the 77 patients without events. LAV-3D (P < .001) and age (P < .05) were independent predictors of cardiac events by Cox proportional hazard model, whereas LAV-2D was negatively involved. Patients with initial LAV-3D less than 100 mL had a significantly higher 1-year event-free survival than those with LAV-3D greater than or equal to 100 mL (80 +/- 7 vs 48 +/- 10%, P < .001).
Conclusions:
LAV-3D is a major predictor of clinical events in patients with severe left ventricular dysfunction and in sinus rhythm. The clinical value of LAV-3D seems to be superior to that of LAV-2D.
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