Measurement Of Left Atrial Size Research Articles

Measurement of left atrial size as a predictor of severity of illness in sickle cell disease

BackgroundSickle cell disease (SCD) is characterized by microvascular occlusion which leads to multiorgan damage, including left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction has been shown to be an independent risk factor for death in SCD patients. Left atrial dilation (LAD) has been used as a surrogate marker for identification of left ventricular diastolic dysfunction. ObjectiveInvestigate the association of LAD, as determined by echocardiography, with increased disease burden in SCD as reflected by increased emergency department (ED) utilization, increased hemolysis markers, and worsening anemia. MethodsA retrospective cohort study of patients from a single university hospital were selected from a national registry. Age, sickle cell phenotype, echocardiogram findings, ED utilization, baseline hemoglobin, and lab values needed for calculation of hemolytic index were recorded for each patient. Patients were then stratified into two distinct groups based on the presence or absence of LAD to compare ED utilization, baseline hemoglobin and hemolytic index between the two groups. Results129 patients met the criteria for inclusion with 88 having normal left atrial volume and 41 with LAD. There was a higher percentage of high ED utilizers in the LAD group compared to the normal left atrial volume group [34% vs. 17%, p = 0.03]. Average hemoglobin was lower in the LAD group compared with the normal left atrial volume group [mean 8.57 g/dL vs. 9.47 g/dL, p = 0.011]. The mean hemolytic index was higher in the LAD group when compared with the normal left atrial volume group [0.44 vs. −0.21, p < 0.001]. ConclusionsLAD was associated with higher ED utilization, lower hemoglobin level, and more hemolysis in patients with SCD.

Efficacy of a mitral regurgitation severity index to predict long-term outcome in dogs with myxomatous mitral valve disease.

Predicting progression of myxomatous mitral valve disease (MMVD) in dogs can be challenging. The mitral regurgitation severity index (MRSI) will predict time to congestive heart failure (CHF) and all-cause death in dogs with MMVD. Eight hundred sixty-nine client-owned dogs. Retrospective study pooling data from 4 previous samples including dogs with MMVD stage B2 or C. MRSI was calculated as: (heart rate [HR]/120) × left atrium-to-aorta ratio (LA:Ao) × (age in years/10) × 100. Alternative MRSI formulas substituting radiographic measures of left atrial size were also calculated. Cox proportional hazard modeling and time-dependent receiver-operator characteristic curves quantified prognostic performance. For Stage B2 pooled samples, MRSI > 156 was predictive of time to CHF (median 407 vs 1404 days; area under the curve [AUC] 0.68; hazard ratio 3.02 [95% CI 1.9-4.9]; P < .001). MRSI > 173 was predictive of all-cause death (median survival 868 vs 1843 days; AUC 0.64; hazard ratio 4.26 [95% CI 2.4-7.5]; P < .001). MRSI showed superior predictive value compared to the individual variables of HR, LA:Ao, and age. Variations of the MRSI equation substituting radiographic vertebral left atrial size for LA:Ao were also significantly predictive of outcome in stage B2. MRSI was not consistently predictive of outcome in Stage C. MRSI was predictive of outcome (onset of CHF and all-cause death) in MMVD Stage B2, demonstrating utility as a useful prognostic tool. Echocardiographic LA:Ao can be effectively replaced by radiographically determined LA size in the MRSI formula.

Observation of Post-Operative Support among LAVI and AF after MVR in Patients with Mitral Valve Disease

Introduction: Mitral valve disease is a common heart condition that may require mitral valve replacement (MVR) surgery. One of the potential complications after MVR is the development of atrial fibrillation (AF). Left atrial volume index (LAVI) is a measure of left atrial size that has been linked to the development of AF in patients with mitral valve disease. The present study aimed to observe the post-operative support needed by patients after MVR surgery, particularly those with elevated LAVI and the incidence of post-operative AF. Methods: This prospective observational study was conducted at the Department of Cardiac Surgery, National institute of cardiovascular diseases (NICVD), Sher-e-Bangla Nagar, Dhaka, Bangladesh. The study duration was 1 year, from Mar, 2018 to Feb, 2019. During this period, a total of 60 patients who underwent Mitral Valve Replacement (MVR) for mitral valve diseases at the study hospital were included in the study following the inclusion and exclusion criteria through a purposive sampling method. The 60 patients were divided in two equal groups, Group A, consisting of 30 Patients who had Left Atrial Volume Index of ≥ 39 ml/m2 after operation, while group B had been comprised of 30 patients who had Left Atrial Volume Index of &lt; 39 ml/m2 after operation. Result: Around 23.33% of participants in both groups were aged 21-30, while 40% of Group A and 36.66% of Group B were aged 31-40. In terms of BMI, 53.33% of Group A and 46.66% of Group B had a normal BMI, while 40% and 43.33% were overweight, and 6.66% and 10% were obese, respectively. Specifically, 23.33% of participants in Group A developed post-operative AF, while only 6.66% of participants in Group B developed it. The p-value for this comparison was 0.015. The results demonstrate that Group B had significantly smaller LA diameter, LA volume, LAVI, LVIDS, and LV ejection fraction compared to Group A at all three measurements post-operation (p&lt;0.05). However, there was no significant ...

Association of Echocardiographic Measures of Left Atrial Function and Size With Incident Dementia

Atrial myopathy-characterized by alterations in left atrial (LA) function and size-is associated with ischemic stroke, independent of atrial fibrillation (AF). Electrocardiographic markers of atrial myopathy are associated with dementia, but it is unclear whether 2-dimensional echocardiographic (2DE)-defined LA function and size are associated with dementia. To examine the association of LA function and size with incident dementia. The Atherosclerosis Risk in Communities (ARIC) study is a community-based prospective cohort. An exploratory, retrospective analysis was conducted. ARIC centers are located in Forsyth County, North Carolina; Jackson, Mississippi; Washington County, Maryland; and suburban Minneapolis, Minnesota. For this analysis, visit 5 (2011-2013) served as the baseline. Participants without prevalent AF and stroke and who had 2DEs in 2011-2013 were included and surveilled through December 31, 2019. LA function (reservoir strain, conduit strain, contractile strain, emptying fraction, passive emptying fraction, and active emptying fraction), and LA size (maximal and minimal volume index) as evaluated by 2DE. Dementia cases were identified using in-person and phone cognitive assessments, hospitalization codes, and death certificates. Cox proportional hazards models were used. Among 4096 participants (mean [SD] age, 75 [5] years; 60% women; 22% Black individuals), 531 dementia cases were ascertained over a median follow-up of 6 years. Dementia incidence for the lowest LA quintile was 4.80 for reservoir strain, 3.94 for conduit strain, 3.29 for contractile strain, 4.20 for emptying fraction, 3.67 for passive emptying fraction, and 3.27 for active emptying fraction per 100 person-years. After full-model adjustments, there were statistically significant associations between measures of LA function and dementia; the hazard ratios (HRs) from the lowest vs highest quintile for reservoir strain were 1.98 (95% CI, 1.42-2.75); for conduit strain, 1.50 (95% CI, 1.09-2.06); for contractile strain, 1.57 (95% CI, 1.16-2.14); for emptying fraction, 1.87 (95% CI, 1.31-2.65); and for active emptying fraction, 1.43 (95% CI, 1.04-1.96). LA passive emptying fraction was not significantly associated with dementia (HR, 1.26 [95% CI, 0.93-1.71]). Dementia incidence for the highest LA maximal volume index quintile was 3.18 per 100 person-years (HR for highest vs lowest quintile, 0.77 [95% CI, 0.58-1.02]) and for the highest minimal volume index quintile was 3.50 per 100 person-years (HR for the highest vs lowest quintile, 0.95 [95% CI, 0.71-1.28]). Both measures were not significantly associated with dementia. These findings were robust to sensitivity analyses that excluded participants with incident AF or stroke. In this exploratory analysis of a US community-based cohort, several echocardiographic measures of lower LA function were significantly associated with an increased risk of subsequent dementia. Measures of LA size were not significantly associated with dementia risk. These findings suggest that impaired LA function may be a risk factor associated with dementia.

Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Cats With Hypertrophic Cardiomyopathy.

ObjectiveTo assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR) for cardiac death in cats with hypertrophic cardiomyopathy.Study DesignProspective observation study.AnimalsNinety-six client-owned cats.MethodsComplete blood count samples were collected from 38 healthy and 58 cats with hypertrophic cardiomyopathy (HCM), and the NLR ratios were analyzed. All cats had echocardiographic measurements performed on the same day as blood collection. Spearman rank correlation was used to assess the relationship between echocardiographic measurements and NLR. Long-term outcome data were obtained, and time to cardiac death and variables associated with cardiac death were analyzed using Kaplan–Meier survival curves and Cox proportional hazards models, respectively.ResultsThe NLR was significantly higher in cats with confirmed congestive heart failure. When evaluating HCM patients, cats in the third NLR tertile had a significantly higher risk of cardiac death with a hazard ratio of 10.26 (95% CI: 1.84–57.14; p = 0.0001) when compared with that of patients in the first tertile. NLR was significantly associated with echocardiographic measures of left atrial size, left auricular function, the presence of left atrial spontaneous echo contrast (SEC), and thrombus formation.Conclusions and Clinical RelevanceIncreased NLR is a negative prognostic indicator in cats with HCM.

Performance of Different Echocardiographic Measurements of Left Atrial Size in Dogs by Observers with Different Levels of Experience.

Simple SummaryAssessing enlargement of the left atrium (one of the four cardiac chambers) is extremely important for gaining information about dogs’ heart disease, their prognosis, and directing treatment. However, people with different levels of experience may be required to make this assessment, and we don’t know how observers with different experiences perform in making this assessment. In this study, five observers with different levels of experience evaluated the left atrium of 36 dogs in a blinded fashion (i.e., unaware of each other measurements, or of the identity of the dog), compared to two cardiologists. We then used statistical analysis to evaluate repeatability, reproducibility, accuracy of the measurements, and the capacity of correctly identifying left atrial enlargement. We found that the measurements performed by observers with more experience where more similar to the cardiologists’ measurements, and that combining more than one technique for measuring the left atrium can improve accuracy of the identification of left atrial enlargement.Assessment of left atrial (LA) sizes in dogs informs clinical staging, risk assessment, treatment decisions, and prognosis. The objective of this study was to assess the diagnostic performance of observers with different levels of experience measuring the LA with three different techniques. Echocardiographic images from 36 dogs with different degrees of left atrial enlargement (LAE) were retrospectively retrieved, anonymized and measured in a blinded fashion by a veterinary student, a first-year cardiology resident, a third-year cardiology resident, and two board-certified veterinary cardiologists. The LA to aortic root ratio (LA:Ao), LA antero-postero diameter indexed to body weight (LAiAPD) and left atrial area were measured. Inter- and intra-observer intraclass correlation coefficients (ICCs) were calculated for all three variables. Bland–Altman plots and accuracy in identification of LAE were calculated for the three least experienced observers using LA:Ao and LAiAPD. Intra- and interobserver ICCs were greater than 0.9 for every variable. The observer with least experience had significant positive bias and a tendency to overestimate larger measurements using LA:Ao, but not using LAiAPD. The accuracy of identification of LAE also increased with the increasing level of experience and was higher for LAiAPD compared to LA:Ao. Combining both methods for identification of LAE, further increased accuracy.

Quantifying Left Atrial Size in the Context of Atrial Fibrillation Ablation: Which Echocardiographic Method Correlates to Outcome of Pulmonary Venous Isolation?

Introduction: Multiple studies have shown that left atrial (LA) enlargement is a strong predictor of poor outcome after catheter ablation of atrial fibrillation (AF). LA size is commonly approximated as the diameter in the parasternal long axis. It remains unknown whether more precise echocardiographic measurements of LA size allow for better correlation with outcome after pulmonary vein isolation (PVI). Methods and results: We performed a retrospective study of 131 consecutive patients (43 females, 60% paroxysmal AF, mean CHA2DS2-Vasc score 1.6, mean age 61 ± 12 years) referred for PVI. Measurements of the LA were carried out by a single observer in transthoracic echocardiograms (TTE) performed prior to ablation. We calculated diameter of the LA in the parasternal long axis (PLAX), LA area in the 2- as well as 4-Chamber (CH) view. LA volume was computed using the disc summation technique (LAV) and indexed to body surface area (LAVI). Procedural and follow-up data were gathered from a prospective AF database. Ablation was performed exclusively using the second generation cryoballoon by the same operators. Follow-up visits at 3, 6 and 12 months showed freedom from AF in 76%, 73% and 73% respectively. Mean values of LA calculations were LAPLAX: 37.9 mm ± 6.3 mm, 2CH area: 22.5 cm2 ± 6.7 cm2, 4CH area: 21.4 cm2 ± 5.5 cm2, LAV: 73.7 mL ± 26.1 mL and LAVI: 36.2 mL/m2 ± 12.7 mL/m2, respectively. C statistic revealed the best concordance of LAVI with outcome after 12 months (C = 0.67), LAV also exhibited a satisfactory value (C = 0.61) in comparison to surfaces in 2CH (C = 0.59) and 4CH (C = 0.57). PLAX showed the worst correlation (C = 0.51). Additionally, different binary logistic regression models identified three independent predictors of AF outcome after cryoballoon PVI: gender (OR = 0.95 per year; p = 0.01); LAV (OR = 1.3/10mL; p = 0.02) and LAVI (OR = 1.58/10 mL/m2; p = 0.02). In all models, PLAX and area measurements were not predictive. Conclusions: Our data add further to evidence that LA size lends itself well as a predictor of PVI outcome. LAVI and LAV were independently predictive of rhythm outcome after PVI. This did not hold true for more commonly used measurements, such as PLAX diameter and surfaces of the LA, irrespective of the view chosen.

Association of Left Atrial Metrics with Atrial Fibrillation Rehospitalization and Adverse Cardiovascular Outcomes in Patients with Nonvalvular Atrial Fibrillation following Index Hospitalization

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with significant clinical and economic burdens, largely driven by adverse cardiovascular outcomes and AF-related hospitalization. Left atrial (LA) parameters have been shown to have prognostic value in cardiovascular disease states. We sought to evaluate the prognostic value of measures of LA size and function, as measured through LA volume index and LA emptying fraction (LAEF), respectively, for AF rehospitalization and long-term adverse outcomes in patients with nonvalvular AF following index hospitalization. In this retrospective study, 594 consecutive patients (mean age, 67.8±13.6years, 53% men) admitted to a tertiary referral center with nonvalvular AF were assessed. Patients who underwent transthoracic echocardiography during their index admission and had complete follow-up data were included and followed for a mean period of 33.18±21.27months for the primary outcome of AF rehospitalization. The secondary outcome was a composite of all-cause death and major adverse cardiovascular events. The primary outcome occurred in 250 (42%) patients, and the secondary outcome occurred in 219 (37%) patients. On multivariable regression analysis, LAEF had an independent association with AF rehospitalization (hazard ratio [HR]=0.967; 95% CI, 0.953-0.982; P<.01), and time-dependent receiver operating characteristic curves demonstrated LAEF to have strong diagnostic accuracy in predicting early and intermediate AF rehospitalization. Both LA volume index (HR=1.014; 95% CI, 1.003-1.026; P=.01) and LAEF (HR=0.982; 95% CI, 0.970-0.993; P<.01) were associated with all-cause death and major adverse cardiovascular events. Adverse LA remodeling, as reflected through LA enlargement and reduced LA mechanical function, is associated with AF rehospitalization and long-term adverse cardiovascular outcomes in hospitalized patients with nonvalvular AF.

Left Atrial Mechanics Assessed Early during Hospitalization for Cryptogenic Stroke Are Associated with Occult Atrial Fibrillation: A Speckle-Tracking Strain Echocardiography Study

Occult atrial fibrillation (AF) is an important contributor to cryptogenic stroke, yet remains difficult to unmask at presentation. This study investigated the predictive value of left atrial (LA) mechanics by strain echocardiography during stroke hospitalization for the presence of AF as detected on early 30-day monitoring and routine clinical follow-up. Left atrial mechanics were studied by strain echocardiography in a retrospective cohort of 191 patients with cryptogenic stroke and 30-day mobile cardiac outpatient telemetry poststroke to diagnose AF. After this, AF was diagnosed via routine clinical follow-up. The independent and incremental value of measures of LA size and mechanics (i.e., strain and strain rate in the reservoir, conduit, and booster pump phase) to predict AF on top of clinical characteristics was assessed. Of 191 patients, 15% (n=28) developed AF, of which 10 were observed during 30-day mobile cardiac outpatient telemetry and 18 were observed at a median follow-up of 25 (interquartile range, 10-43) months. Median time from embolic stroke to strain echocardiography was 1day (interquartile range, 1-2days). Left atrial mechanics were significantly worse in AF (P<.05 for all), despite largely similar baseline cardiovascular risk profile. Booster pump strain rate was the strongest predictor for AF, independent of age, LA volume index, E/e', and reservoir strain (odds ratio=2.88 per SD increase; 95% confidence interval, 1.29-6.41; P=.010). Adding LA strain reservoir strain and booster pump function significantly enhanced a multivariate model to predict AF. Freedom from AF was significantly lower in subjects with a booster pump strain rate (at stroke presentation) worse than -0.67sec-1, as derived from receiver operator curve analysis (P<.001). Left atrial mechanics and particularly the LA booster pump function assessed early during hospitalization for cryptogenic stroke can identify patients at greater likelihood of future diagnosis of AF. These findings could in part relate to LA mechanical stunning after spontaneous cardioversion, which-when identified by early strain echocardiography-can inform further risk stratification and decision-making.

Left Atrial End-Diastolic Volume Index as a Predictor of Cardiovascular Outcomes: The Heart and Soul Study.

The left atrial end-systolic volume index (LAESVI) is a predictor of cardiovascular outcomes and is the recommended measurement of left atrial size. The left atrial end-diastolic volume index (LAEDVI), representing the minimum or residual left atrial volume, has not been fully evaluated as a predictor of cardiovascular events. This study evaluated the predictive power of LAEDVI compared with LAESVI for heart failure (HF) hospitalizations, a composite of HF hospitalizations, myocardial infarction, stroke, and heart disease death, and all-cause mortality. We measured LAESVI and LAEDVI in subjects without atrial fibrillation or flutter or significant mitral valve disease. Using Cox proportional-hazard models, the association of LAESVI and LAEDVI with the stated outcomes was examined. After a mean of 7.3±2.6 years of follow-up, there were 147 HF hospitalizations, 118 myocardial infarctions, 45 strokes, 96 heart disease deaths, and 351 deaths from all causes in 938 subjects. When comparing the highest and the lowest quartiles of LAEDVI, there was a near 6-fold increase in the hazard ratio (HR) for HF hospitalization (HR, 5.96; P<0.001). This was higher than what was seen with LAESVI (HR, 4.85; P<0.001). Similar associations were noted for the composite cardiovascular outcome (HR for LAEDVI, 2.97; P<0.001) and for all-cause mortality (HR for LAEDVI, 2.08; P<0.001). In adjusted models, LAEDVI demonstrated equal or better predictive power than LAESVI for HF hospitalization and the composite cardiovascular outcome. LAEDVI is a strong predictor of cardiovascular events in ambulatory patients with stable coronary heart disease and may merit routine use.

P1784 Atrial function as a stratification tool in cryptogenic stroke

Abstract Introduction In a large proportion of patients with ischemic stroke, no identifiable cause is found. Paroxysmal atrial fibrillation (AF) plays an important role in the pathogenesis of this kind of stroke. Improved stratification of patients with cryptogenic stroke (CS) would be helpful, because these patients with paroxysmal, often silent, AF may benefit from increased monitoring or targeted therapy. Purpose This study aims to identify parameters of left atrial (LA) function that could be used as an imaging biomarker to predict AF in patients with recent CS. Methods We retrospectively examined echocardiographic measurements of LA size and function in 58 patients who received an implantable loop recorder (ILR) for CS from January 2010 till October 2018. Only patients in whom the echocardiography was performed within a week after CS were included. Patients with poor imaging quality for atrial strain measurements were excluded. Differences among groups of continuous variables were determined by the student t-test. Categorical variables were compared by χ2 analysis. ROC curves were constructed to assess the sensitivity and specificity. The optimal ROC-derived cut-off levels were determined using the Youden’s J statistic. Results 17 of the 58 patients (29.3%) developed AF, detected by ILR. The mean time for diagnosis after implantation was 144.29 ± 182.20 days. There was no statistical difference in age (64,8 ± 12,7 vs 62,9 ± 11,9 yrs, p 0,606), gender (76,5 vs 53,7% female, p 0,106) or CHA2DS2-VASc score (5,0 ± 1,3 vs 4,3 ± 1,4, p 0,855) between the AF group and non-AF group. LA volume was significant higher in the patients who developed AF (29,1 ± 10,8 vs 43,6 ± 17,8 ml/m2, p 0.005). Reservoir strain (ƐR; 28,7 ± 5,6 vs 18,1 ± 5,2%, p &amp;lt;0.001), conduit strain (ƐCd; 13,0 ± 4,3 vs 10,3 ± 4,3%, p 0.038) and contractile strain (ƐCt; 15,6 ± 4,1 vs 7,8 ± 2,9%, p &amp;lt;0.001) were all significant lower in the AF group, as were peak early and peak late negative strain rate (SRe; 1,3 ± 0,6 vs 0,9 ± 0,4 1/s, p 0.011 and SRa; 1,9 ± 0,6 vs 1,0 ± 0,4 1/s, p &amp;lt;0.001 respectively). Also, color TDI septal a’ and lateral a’velocity (7,4 ± 1,5 vs 5,4 ± 1,4 cm/s, p &amp;lt;0,001 and 7,2 ± 2,0 vs 5,0 ± 1,6 cm/s, p &amp;lt;0,001 respectively) were lower in the AF group. Total atrial conduction time (PA-TDI interval) was longer in the AF group (130 ± 25,7 vs 152 ± 30,4 ms, p 0,027). Finally, LAVI/ ƐR ratio was found to be higher in the AF group (3,2 ± 3,4 vs 1,1 ± 0,7, p &amp;lt;0,001). The optimal ROC derived cut-off value of LAVI/ ƐR ratio was 1,3 with a sensitivity of 93,8% and a specificity of 73,7% (AUC 0,9). Conclusions Novel LA parameters have an additive value to current risk-prediction models for predicting AF following CS. LAVI/ƐR ratio is a strong imaging parameter to predict AF in this cohort. Further studies are necessary to investigate if this parameter could have an implication for the decision making of implanting an ILR or for starting early, empiric anticoagulation.

Echocardiographic quantitation of left heart size and function in 122 healthy dogs: A prospective study proposing reference intervals and assessing repeatability

BackgroundBroadly applicable reference intervals (RIs) for measurements of left atrial (LA) and left ventricular (LV) size and function generated prospectively using statistically appropriate methods are limited.ObjectivesTo generate body size‐independent RIs for linear, area, and volume measurements of LA size and LV size and function.AnimalsHealthy adult dogs (n = 122) of variable size and somatotype.MethodsProspective study. All dogs underwent an echocardiogram performed by the same examiner. Effects of body weight, sex, age, and heart rate were evaluated by regression and correlation analyses. Scaling exponents and prediction intervals were generated for linear measurements using the allometric equation. After normalization to body weight, 95% RIs were determined using nonparametric methods with 2.5 and 97.5 percentiles serving as the lower and upper limits (each with 90% confidence intervals), respectively.ResultsLinear LA and LV measurements were strongly correlated (R 2 ≥ 0.79) with body weight. Scaling exponents were close to the expected 1/3 (0.299‐0.392). Prediction intervals for linear measurements of LV chamber size were considerably narrower than previously reported. Weak correlations (r = −0.42 to −0.50) among LV fractional shortening, fractional area change, and ejection fraction and body weight were identified. No other meaningful relationships were identified between the measurements and sex, age, and heart rate.Conclusions and Clinical ImportanceBody size‐independent RIs for several linear, area, and volume measurements of LA and LV size and function were generated prospectively from a large and diverse reference population and are available for clinical use.

Left atrial size and volume in cats with primary cardiomyopathy with and without congestive heart failure

Introduction/objectivesMyocardial diseases are the most common acquired cardiac diseases in cats and may result in left atrial enlargement and congestive heart failure (CHF). Volume calculations have replaced linear measurements for chamber quantification in humans but are not commonly measured in cats. The aims of this retrospective study were to compare the left atrial (LA) size by two-dimensional linear measurements to two-dimensional LA volumes (LAV). AnimalsOne hundred sixty-two client-owned cats were included. Materials and methodsCats with complete echocardiographic examinations were included and categorized into one of the three groups: healthy, cardiomyopathy (CM), and CHF. Seven measurements of the LA size were performed including minimal and maximal LA-to-aortic ratio (LA:Ao) and LAV and also maximal left atrial diameter (LAD). ResultsCats were classified as healthy (n = 56), CM (n = 62), and CHF (n = 44). The minimal LA:Ao (LA:Aomin) and minimal LAV from the left apical view (LAVmin-LAP) best differentiated the CM and CHF groups. The LA:Aomin value with the optimal sensitivity and specificity to distinguish CM and CHF cats was 1.64 (sensitivity 84% and specificity 75%). ConclusionsLeft atrial volumes were not superior to linear measurements of LA size in distinguishing CM and CHF cats in this study. Minimal LA size and volumes resulted in a larger area under the curve than each corresponding maximal value. Minimum LA size may be a better prognostic factor of CHF in cats with CM.

Evaluation of Echocardiographic Parameters in Patients with White Coat and Masked Hypertension Detected by Ambulatory Blood Pressure Monitoring

The aim of this study was to assess the echocardiographic changes in patients who have masked hypertension (MH) and white coat hypertension (WCH) depending on monitoring of blood pressure by ambulatory method. This study was conductedon (66) subjects in a private clinic in Al-Hilla city; the subjects underwent a (24 hours) ABPM in addition to atransthoracic echocardiography. Based on the readings of ABP measurements, average and maximum (24 hours) diastolic and systolic blood pressures (BP) were analyzed during mean nighttime (from 10 p.m. to 6 a.m.) and during mean daytime (from 6 a.m. to 10 p.m.). The echocardiographic parameters included the measurement of left atrial size, left atrial diameter (LAD), posterior cardiac wall thickness (PWT), anterior cardiac wall thickness (AWT), E/A ratio, left ventricular end-diastolic diameter (LVEDD), and isovolumic relaxation time (IVRT). The percentage of patients having WCH was higher than MH 41: 66 (62%) vs. (38%) (25: 66). Regarding WCH, there were few patients had personal history of hypertension 5 (12%) and most of them had family history of hypertension 36 (88%), while in case of MH, all patients had negative personal history of hypertension and most of them had negative family history 21 (84%) of hypertension.

Which is the Best Measure of Left Atrial Size Following Myocardial Infarction: Minimal or Maximal Volume? Insights from Prognostic and Haemodynamic Validation

Which is the Best Measure of Left Atrial Size Following Myocardial Infarction: Minimal or Maximal Volume? Insights from Prognostic and Haemodynamic Validation

Left atrial anteroposterior diameter in dogs: reference interval, allometric scaling, and agreement with the left atrial-to-aortic root ratio.

Left atrial enlargement (LAE) is a well-known negative prognostic factor in dogs with myxomatous mitral valve disease (MMVD). Left atrial-to-aortic root ratio (LA/Ao) is the most commonly used method to evaluate left atrial (LA) size in dogs, while the left atrial anteroposterior diameter (LAD) has been proposed as an additional measurement of LA size in different species. The aim of this study was to establish a normal reference range of LAD normalized to body weight (LADn) in dogs using allometric scales, and to evaluate the agreement between LADn and LA/Ao in the detection of LAE in dogs with MMVD. This was a retrospective, multicenter, observational study. We included 330 healthy dogs, 30 dogs with MMVD in ACVIM stage B1, 30 dogs in ACVIM stage B2, and 30 dogs in ACVIM stage C. The reference range for the LAD, depending on body weight, was between 16.91 mm and 49.68 mm. The reference range for the LADn in healthy dogs was between 10.49 and 15.72. LADn was significantly greater in dogs with MMVD compared to healthy dogs, and a significant difference in LADn was noted between different ACVIM stages (P<0.001). The most accurate cut-off value of LADn to differentiate between dogs in groups B2 and C was 20.3 (sensitivity, 83.3%; specificity, 83.3%). There was a misclassification rate of 37% between LADn and LA/Ao in the detection of LAE in group B1. This study provides a normal reference range for LAD in dogs, which can be used as an additional tool to assess LAE in dogs with MMVD.

Impact of early chronic kidney disease on left atrial function and volume

Background: Chronic kidney disease (CKD) is one of the most important factors affecting cardiovascular morbidity and mortality. Left atrial (LA) volume indexed (LAVI) for body surface area is the most accurate measure of LA size that was obtained by standard echocardiography. The aim of this study was to investigate the value of strain analysis and LA volume in the detection of myocardial involvement in early CKD. Methods: The study included 60 patients divided into two groups: Group I: patients with early CKD (estimated glomerular filtration rate >30 ml/min/1.73 m2) without any previous cardiac illness and Group II: healthy age-matched controls with normal renal function. Echocardiographic examinations including LAVI and LA strain were measured in all participants. Results: LA wall systolic strain values decreased in the CKD group compared to the healthy control group (16.23% ± 6.33% vs. 38.84% ± 9.37%, P < 0.0001, on the lateral wall; 14.16% ± 3.64% vs. 26.66% ± 9.75%, P < 0.0001, on the septal wall; 17.23% ± 8.41% vs. 32.23% ± 7.92%, P < 0.0001, on the anterior wall; and 19.65% ± 7.58% vs. 47.48%–11.24%, P < 0.0001, on the inferior wall). LA systolic strain was more reduced in Stage 3 CKD than Stages 1 and 2. LAVI was significantly larger in the CKD group compared to healthy controls (36.20 ± 8.21 vs. 22.18 ± 3.00 ml/m2, P < 0.0001). Conclusion: LA function evaluated by strain is reduced and LA volume is increased in the early stages of CKD, and Stage 3 CKD is the most affected stage.

A radiographic measurement of left atrial size in dogs

BackgroundThe dimensions of the left atrium in cases with mitral regurgitation are an indirect measurement of its severity. The objective of this study was to evaluate the value of a new radiographic measurement, the radiographic left atrial dimension (RLAD), for detecting left atrial enlargement (LAE) in dogs. Thirty one dogs without LAE and 46 dogs with LAE were recruited in a prospective fashion. Reference left atrium dimension was measured by standard left atrium to aorta ratio (LA/Ao) by 2D echocardiography. LAE was considered if LA/Ao > 1.6. Left atrium dimension was then quantified on lateral radiographs by measuring RLAD. Vertebral heart size (VHS) was measured and RLAD was obtained by drawing a line bisecting the 90 degrees angle defined by the long and short cardiac axes lines of the VHS, up to the dorsal edge of the left atrium and comparing its length to T4’s vertebral body length. The correlation of VHS and RLAD methods with LA/Ao was estimated, as well as their sensitivity and specificity for detecting LAE. Receiver Operating Characteristic (ROC) curves were used to estimate the optimal decision criteria for each method.ResultsA positive correlation was observed between RLAD and LA/Ao (r = 0.82). RLAD’s sensitivity and specificity for detecting LAE when evaluated at the optimal cut-off value, 1.8 vertebrae, were 93.5 and 96.8% respectively. RLAD showed high reproducibility and repeatability.ConclusionRLAD appears to be a clinically useful radiographic measurement for evaluating left atrial dimensions. RLAD would provide clinicians with a simple and cost-effective tool for evaluating and monitoring LAE.

Interatrial block and atrial remodeling assessed using speckle tracking echocardiography

BackgroundTo evaluate the possibility of left atrial (LA) remodeling using speckle tracking echocardiography (STE) in patients with interatrial block (IAB).MethodsWe performed a cross-sectional study with three groups of patients: 56 without IAB, 21 with partial IAB (pIAB), and 22 with advanced IAB (aIAB). Transthoracic echocardiographic (TTE) STE was performed and clinical and echocardiographic findings were analyzed.ResultsTTE showed higher LA volume/body surface area in the patients with IAB. With STE, the absolute value of strain rate during atrial booster pump function (SRa) and early reservoir period (SRs) decreased in the pIAB group and even more in the aIAB group, compared to the group without IAB. The independent variables were the echocardiographic measures of LA size and function. After adjusting for confounders, both multiple linear regression and multivariate multinomial regression showed good correlation with dependent variables: longer P-wave duration on electrocardiography and with the type of IAB, respectively. SRa (p < 0.001), SRs (p < 0.001), and maximal peak LA longitudinal strain in the reservoir period (p = 0.009) were independently associated with P-wave duration. SRa was also associated with the presence of pIAB (OR = 11.5; 95% confidence interval (CI): 2.7–49.0; p = 0.001) and aIAB, (OR = 98.2; 95% CI: 16–120.4; p < 0.001) and SRs was associated with pIAB (OR: 0.03; CI: 0.003–0.29; p = 0.003) and with aIAB (OR: 0.008; CI: 0.001–0.12; p = 0.004).ConclusionsIAB correlates directly with structural remodeling and a decrease in the absolute value of LA SRa and SRs determined using STE.

Two-dimensional echocardiographic estimates of left atrial function in healthy dogs and dogs with myxomatous mitral valve disease

ObjectivesTo provide reference intervals for 2-dimensional linear and area-based estimates of left atrial (LA) function in healthy dogs and to evaluate the ability of estimates of LA function to differentiate dogs with subclinical myxomatous mitral valve disease (MMVD) and similarly affected dogs with congestive heart failure (CHF). AnimalsFifty-two healthy adult dogs, 88 dogs with MMVD of varying severity. MethodsLinear and area measurements from 2-dimensional echocardiographs in both right parasternal long and short axis views optimized for the left atrium were used to derive estimates of LA active emptying fraction, passive emptying fraction, expansion index, and total fractional emptying. Differences for each estimate were compared between healthy and MMVD dogs (based on ACVIM classification), and between MMVD dogs with subclinical disease and CHF that had similar LA dimensions. Diagnostic utility at identifying CHF was examined for dogs with subclinical MMVD and CHF. Relationships with bodyweight were assessed. ResultsAll estimates of LA function decreased with increasing ACVIM stage of mitral valve disease (p<0.05) and showed negative relationships with increasing LA size (all r2 values < 0.2), except for LA passive emptying fraction, which did not differ or correlate with LA size (p=0.4). However, no index of LA function identified CHF better than measurements of LA size. Total LA fractional emptying and expansion index showed modest negative correlations with bodyweight. ConclusionsEstimates of LA function worsen with worsening MMVD but fail to discriminate dogs with CHF from those with subclinical MMVD any better than simple estimates of LA size.