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Which method of left atrium size quantification is the most accurate to recognize thromboembolic risk in patients
Ana Faustino1, Rui Providência, Sérgio Barra
1Cardiology Department, Coimbra's Hospital and University Centre - General Hospital, Coimbra, Portugal. anacatarina.faustino@gmail.com.
Insights
Left atrial enlargement in atrial fibrillation (AF) patients predicts stroke risk. Indexed LA area and area-length volumes are accurate measures for identifying thromboembolic risk markers.
Area of Science:
- Cardiology
- Echocardiography
- Thromboembolic Risk Assessment
Background:
- Left atrial (LA) size predicts cardiovascular outcomes in sinus rhythm but yields conflicting results in atrial fibrillation (AF).
- Evaluating LA size in AF is crucial for identifying thromboembolic risk.
- Current methods for LA size assessment in AF require further validation.
Purpose of the Study:
- To assess the accuracy of LA size measurements in identifying stroke risk markers in non-valvular AF patients.
- To determine the optimal echocardiographic method for evaluating LA size in this population.
- To correlate LA size with specific surrogate markers of thromboembolic events.
Main Methods:
- A cross-sectional study included 500 consecutive patients with non-valvular AF undergoing echocardiography.
- LA size was measured using transthoracic echocardiography (anteroposterior diameter, area, volumes).
- Transesophageal echocardiography assessed stroke risk markers: LA appendage thrombus, low flow velocities, spontaneous echo contrast, and LA abnormality.
Main Results:
- Most LA size measurements, except non-indexed anteroposterior diameter, effectively identified stroke risk markers.
- Indexed LA area in the four-chamber view and indexed area-length volumes showed high discriminatory power (AUCs ranging from 0.651 to 0.737).
- Indexed LA area and area-length volumes were independent predictors of stroke surrogate markers.
Conclusions:
- Left atrial enlargement is linked to a higher prevalence of stroke risk markers in non-valvular AF.
- Indexed LA area in the four-chamber view and indexed area-length volumes are the most accurate measures for assessing this risk.
- These findings aid in refining risk stratification for stroke in AF patients.
Background:
Left atrial (LA) size is a predictor of cardiovascular outcomes in patients in sinus rhythm, whereas conflicting results have been found in atrial fibrillation (AF). This study aims to: (1) Evaluate the accuracy of LA size to identify surrogate markers of an increased thromboembolic risk in patients with AF; (2) Assess the best method to evaluate LA size in this setting.
Methods:
Cross-sectional study enrolling 500 consecutive patients undergoing transthoracic and transesophageal echocardiography evaluation during a non-valvular AF episode. LA size was measured on transthoracic echocardiography using several methods: anteroposterior diameter, area in four-chamber view, and volumes by the ellipsoid, single- and biplane area-length formulas. Surrogate markers of stroke were evaluated by transesophageal echocardiography: LA appendage (LAA) thrombus, LAA low flow velocities, dense spontaneous echocardiographic contrast and LA abnormality.
Results:
Except for non-indexed anteroposterior diameter, increased LA size quantified by all the other methods showed a moderate to high discriminatory power to identify all the surrogate markers of stroke. A higher accuracy was observed for indexed LA area in four-chamber view (LAA thrombus: AUC = 0.708, CI95% 0.644- 0.772, p<0.001; LAA low flow velocities: AUC = 0.733, CI95% 0.674- 0.793, p<0.001; dense spontaneous echocardiographic contrast: AUC = 0.693, CI95% 0.638- 0.748, p<0.001; LA abnormality: AUC = 0.705, CI95% 0.654-0.755, p<0.001), indexed single-plane area-length volume (LAA thrombus: AUC = 0.701, CI95% 0.633-0.770, p<0.001; LAA low flow velocities: AUC = 0.726, CI95% 0.660-0.792, p<0.001; dense spontaneous echocardiographic contrast: AUC = 0.673, CI95% 0.611-0.736, p<0.001; LA abnormality: AUC = 0.687, CI95% 0.629-0.744, p<0.001), and indexed biplane area-length volume (LAA thrombus: AUC = 0.707, CI95% 0.626-0.788, p<0.001; LAA low flow velocities: AUC = 0.737, CI95% 0.664-0.810, p<0.001; dense spontaneous echocardiographic contrast: AUC = 0.651, CI95% 0.578-0.724, p<0.001; LA abnormality: AUC = 0.683, CI95% 0.617-0.749, p<0.001), without significant difference between them. Indexed LA area in four-chamber view and indexed area-length volumes also were independent predictors of surrogate markers of stroke.
Conclusions:
Left atrium enlargement is associated with an increased prevalence of surrogate markers of stroke in patients with non-valvular AF. Indexed LA area in four-chamber view and indexed area-length volumes displayed the strongest association.
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