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Indexing Left Atrial Volumes: Alternative Indexing Methods Better Predict Outcomes in Overweight and Obese
Esther F Davis1, Daniela R Crousillat2, Wei He3
1Echocardiography Section, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Victorian Heart Institute, Melbourne, Victoria, Australia.
JACC. Cardiovascular Imaging
|June 9, 2022
Summary
Standard body surface area (BSA) indexing may underestimate left atrial (LA) dilation in overweight individuals. Alternative methods like height or height-squared better predict mortality and cardiovascular events in obese patients.
Area of Science:
- Cardiology
- Echocardiography
- Biostatistics
Background:
- Left atrial volume (LAV) is commonly indexed to body surface area (BSA).
- This standard method may underestimate left atrial (LA) dilation in overweight and obese individuals.
- Accurate LA size assessment is crucial for predicting cardiovascular (CV) events and mortality.
Purpose of the Study:
- To evaluate the predictive performance of different LAV indexing methods for mortality and CV events.
- To compare BSA indexing with alternative methods including idealized BSA (iBSA), height, and height-squared (H²).
- To assess the impact of indexing methods on LA dilation classification across various body sizes.
Main Methods:
- LAV was indexed to BSA, iBSA, height, and H² in over 17,000 patients aged >50 years.
- Patients underwent outpatient echocardiography with longitudinal follow-up.
- Mortality and CV events were ascertained through medical records.
Main Results:
- Alternative indexing (iBSA, height, H²) reclassified LA size in up to 28.4% of patients compared to BSA (P < 0.001).
- In severely obese individuals (BMI ≥40 kg/m²), BSA indexing lost predictive power for mortality (P = 0.70).
- Height, H², and iBSA remained predictive, with H² showing the best overall performance for predicting mortality and CV events in overweight/obese populations (P < 0.001).
Conclusions:
- Standard BSA indexing is inadequate for predicting mortality in the severely obese.
- Indexing LAV using height, H², or iBSA improves mortality prediction in obese individuals.
- Alternative indexing methods offer superior predictive performance across overweight and obese populations, preventing underestimation of risk.
