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Usefulness of left atrial volume versus diameter to assess thromboembolic risk in mitral stenosis

Niall G Keenan1, Caroline Cueff, Claire Cimadevilla

  • 1Cardiology Department, AP-HP, Bichat Hospital, Paris, France.

The American Journal of Cardiology
|October 6, 2010
PubMed

Insights

Left atrial volume, not diameter, better predicts thromboembolic risk in mitral stenosis patients. Using indexed LA volume could significantly alter anticoagulation decisions, suggesting a threshold of 60 ml/m² for better management.

Area of Science:

  • Cardiology
  • Echocardiography
  • Thrombosis

Background:

  • Current guidelines recommend anticoagulation for mitral stenosis (MS) patients in sinus rhythm (SR) based on left atrial (LA) diameter.
  • Left atrial enlargement is a known risk factor for thromboembolic events in MS.

Purpose of the Study:

  • To compare the association of LA diameter and LA volume with thromboembolic risk markers in MS patients.
  • To evaluate the utility of LA volume indexed to body surface area (BSA) for guiding anticoagulation decisions.

Main Methods:

  • Transesophageal echocardiography (TEE) was performed in 152 patients with moderate to severe MS.
  • Thromboembolic risk was assessed using peak LA appendage emptying velocity (LAAv) and spontaneous contrast density.
  • LA diameter and LA volume were measured and correlated with risk markers.

Main Results:

  • BSA-indexed LA volume, unlike LA diameter, significantly differentiated patients with high thromboembolic risk (defined by LAAv < 25 cm/s and/or dense spontaneous contrast).
  • BSA-indexed LA volume showed a higher area under the curve (0.85) for predicting high thromboembolic risk compared to LA diameter (0.65).
  • A threshold of 60 ml/m² for BSA-indexed LA volume demonstrated 90% sensitivity for high risk, potentially altering anticoagulation indications in 51-77% of patients.

Conclusions:

  • Left atrial volume is a more robust predictor of thromboembolic risk than LA diameter in MS patients.
  • Utilizing BSA-indexed LA volume, with a suggested threshold of 60 ml/m², may improve the management and anticoagulation decisions in these patients.
  • This approach could lead to significant changes in clinical practice for MS management.

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