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Left atrio-vertebral ratio: A new computed-tomography measurement to identify left atrial dilation
Marie Baque-Juston1, Manuelle Volondat2, Eric Fontas3
1Radiology Department, Hôpital Pasteur, 30 Avenue de la Voie Romaine, 06000 Nice, France.
Insights
A new ratio, the left atrio-vertebral ratio (LAVR), can help diagnose cardiogenic pulmonary edema. A LAVR above 2.1 indicates left atrial dilation and is strongly associated with this condition.
Area of Science:
- Radiology
- Cardiology
- Medical Imaging
Background:
- Cardiogenic pulmonary edema on CT scans typically shows left heart chamber dilation, interstitial lung changes, and pleural effusions.
- Measuring left atrial size is not routinely performed, despite its importance in assessing cardiac function.
- Existing methods for assessing chamber dimensions don't account for patient build or anthropomorphic data.
Purpose of the Study:
- To develop a simple method for scaling left atrial size using readily available data from axial CT images.
- To introduce the left atrio-vertebral ratio (LAVR) by dividing left atrial diameter by thoracic vertebral diameter.
- To evaluate the LAVR's potential as a quick diagnostic criterion by comparing patients with and without cardiogenic pulmonary edema.
Main Methods:
- Two radiologists analyzed CT scans from 32 patients without cardiac disease and 40 with acute cardiac failure.
- The maximum left atrial diameter was measured and divided by the transverse vertebral diameter to calculate the LAVR.
- Receiver operating characteristic (ROC) curves were used to determine the optimal LAVR threshold for diagnosing pulmonary edema.
Main Results:
- The mean LAVR was 1.85 ± 0.27 in asymptomatic patients and 2.48 ± 0.35 in patients with pulmonary edema.
- An LAVR threshold of 2.1 demonstrated 85% sensitivity and 88% specificity for diagnosing cardiogenic pulmonary edema.
- A significant difference in LAVR was observed between the two patient groups.
Conclusions:
- The left atrio-vertebral ratio (LAVR) is a novel, simple measurement that scales left atrial diameter to patient anthropometrics.
- An LAVR above 2.1 is strongly associated with cardiogenic pulmonary edema, suggesting left atrial dilation.
- The significant difference in LAVR between patient groups indicates high potential for clinical application in diagnosing cardiac conditions.
Background:
Left cardiac chambers dilation, interstitial lung changes and pleural effusions are the characteristics of cardiogenic pulmonary oedema on computed tomography (CT) of the chest but mensuration of the left atrial size is not routinely performed. Cardiac chambers normal dimensions are known to be proportional to the patient's build and anthropomorphic data but adjustment of chambers dimensions to available elements seen on the axial CT images has never been evaluated before.
Objectives:
Our objective was to use data easily available on axial images to directly scale the left atrium. We chose to divide the left atrial diameter by the thoracic vertebral diameter, using the latter as a body-mass indicator. As a preliminary study, we aimed to evaluate the range of values of this left atrio-vertebral ratio (LAVR) by comparing patients suffering from cardiogenic pulmonary oedema with patients free of cardiac disease. We hypothesized that if the difference of values in these two populations of patients was significant enough, this ratio would be relevant and could be used as a quick criterion in different clinical situations.
Method:
Two radiologists reviewed CT scans of 32 of patients free of cardiac disease and 40 patients in acute cardiac failure. The maximum diameter of the left atrium at the level of the right inferior pulmonary vein was divided by the vertebral transverse diameter to generate a left atrio-vertebral ratio. Receiver operating characteristic curves identified the threshold associated with pulmonary oedema.
Measurements And Main Results:
The mean LAVR was 1.85 ± 0.27 in asymptomatic patients and 2.48 ± 0.35 in patients with pulmonary oedema. A LAVR of 2.1 yielded 85% sensitivity and 88% specificity for the diagnosis of cardiogenic pulmonary oedema.
Conclusions:
LAVR is a simple new measure directly scaling the left atrial diameter to the anthropomorphic characteristics of the patient. In our series, a ratio above 2.1 is strongly associated with cardiogenic pulmonary oedema indirectly suggesting left atrial dilation. The results were significantly different between the two populations of patients (no heart condition versus cardiogenic pulmonary oedema) suggesting a high potential for clinical application.
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