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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Left atrial volumes: two-dimensional, three-dimensional, cardiac magnetic resonance and computed tomography
1aWestmead Private Cardiology bSouth Western Sydney Clinical School, University of New South Wales, Liverpool Hospital cWestern Clinical School, University of Sydney, New South Wales, Australia.
Insights
Left atrial volume assessment is crucial for cardiovascular health. While 2D echocardiography underestimates volumes, minimum and phasic assessments offer superior prediction of adverse events across imaging modalities.
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- Left atrial volume is a key biomarker for cardiovascular disease and outcomes.
- It correlates with the severity of diastolic dysfunction.
- Accurate measurement is vital for patient risk stratification.
Purpose of the Study:
- To review recent advances in left atrial volume measurement techniques.
- To compare the methodology, prognostic value, and limitations of various imaging modalities.
- To highlight the clinical importance of left atrial volume assessment.
Main Methods:
- Review of current literature on left atrial volume assessment.
- Comparison of 2D echocardiography (2DE), 3D echocardiography (3DE), cardiac magnetic resonance (CMR), and computed tomography (CT).
- Analysis of volumetric assessments, including minimum and phasic volumes.
Main Results:
- Left atrial volume measurements correlate across imaging modalities, but 2DE significantly underestimates values.
- Minimum left atrial volume and phasic function show superior predictive value for major adverse cardiovascular events.
- Volumetric assessments are more predictive than maximum left atrial volume.
Conclusions:
- Different imaging modalities for left atrial volume are not interchangeable, especially for serial measurements.
- Standardization and normative data are needed for newer modalities, incorporating minimum and phasic volumes.
- While 2DE has limitations, its measurements are well-defined and prognostic; further validation of advanced techniques is required.
Purpose Of Review:
Evaluation of left atrial volume is important, as it is a biomarker of cardiovascular disease and outcomes and correlates with diastolic dysfunction severity. Left atrial volume measurements by different imaging modalities, including 2D and 3D echocardiography (2DE and 3DE), cardiac magnetic resonance (CMR) and computed tomography (CT), are reviewed in regard to recent advances, methodology, prognostic value and limitations.
Recent Findings:
Left atrial volume assessments correlate well between the different imaging modalities; however, 2DE significantly underestimates left atrial measurements. Assessment of the left atrial minimum volume and left atrial phasic function derived volumetrically have reported superior predictive value for major adverse cardiovascular events and elevated left ventricular diastolic pressure compared with the left atrial maximum volume.
Summary:
The different imaging modalities used to assess left atrial volumes are not interchangeable, particularly for serial measurements. Although 2DE underestimates left atrial volumes, most normative as well as predictive data have been obtained using this modality. Standardization, with established normative data and classification criteria, needs to be established for other imaging modalities, additionally incorporating assessment of left atrial minimum and phasic volumes. Despite the limitations of the more simplistic 2DE, its measurements are well defined with significant prognostic value. The incremental prognostic value of the more complex imaging techniques needs to be further validated.
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