Left Atrial Volume Measurements Research Articles

Cardiac Remodeling Following Percutaneous Mitral Valve Repair – Initial Results Assessed by Cardiovascular Magnetic Resonance Imaging

Percutaneous mitral valve repair with the MitraClip device (Abbott Vascular, Redwood City, California, USA) is a novel therapeutic option in patients with mitral regurgitation. This study evaluated the feasibility of cardiac volume measurements by cardiovascular magnetic resonance imaging (CMR) to assess reverse myocardial remodeling in patients after MitraClip implantation. 12 patients underwent CMR at baseline (BL) before and at 6 months follow-up (FU) after MitraClip implantation. Cine-CMR was performed in short- and long-axes for the assessment of left ventricular (LV), right ventricular (RV) and left atrial (LA) volumes. Assessment of endocardial contours was not compromised by the device-related artifact. No significant differences in observer variances were observed for LV, RV and LA volume measurements between BL and FU. LV end-diastolic (median 127 [IQR 96 - 150] vs. 112 [86 - 150] ml/m(2); p = 0.03) and LV end-systolic (82 [54 - 91] vs. 69 [48 - 99] ml/m(2); p = 0.03) volume indices decreased significantly from BL to FU. No significant differences were found for RV end-diastolic (94 [75 - 103] vs. 99 [77 - 123] ml/m(2); p = 0.91), RV end-systolic (48 [42 - 80] vs. 51 [40 - 81] ml/m(2); p = 0.48), and LA (87 [55 - 124] vs. 92 [48 - 137] ml/m(2); p = 0.20) volume indices between BL and FU. CMR enables the assessment of cardiac volumes in patients after MitraClip implantation. Our CMR findings indicate that percutaneous mitral valve repair results in reverse LV but not in RV or LA remodeling. • Volume measurements by cardiovascular magnetic resonance imaging are feasible following percutaneous mitral valve repair despite device-related artifacts.• A significant reduction of left ventricular volume was found in terms of beneficial, reverse left ventricular remodeling after 6-month follow-up.• No significant reduction was found in right ventricular or left atrial volumes after percutaneous mitral valve repair after 6-month follow-up.

Left atrial size, atrial function and left ventricular diastolic function in cats with hypertrophic cardiomyopathy

To describe left atrial size, left atrial volume, left atrial function and left ventricular diastolic function in healthy cats and those with hypertrophic cardiomyopathy without and with congestive heart failure. A retrospective study of 61 client-owned, 21 healthy, 21 asymptomatic hypertrophic cardiomyopathy and 19 with hypertrophic cardiomyopathy and congestive heart failure cats. Data were retrieved from clinical records and echocardiography archives. Left atrial diameter and volumes were measured. Left atrial function was investigated using changes in diameter (fractional shortening) and volume (Simpson's method; left atrial ejection fraction). Conventional echocardiographic indices of left ventricular diastolic function were recorded. Left atrial diameter and left atrial volume measurements were significantly higher in hypertrophic cardiomyopathy with congestive heart failure cats compared with asymptomatic hypertrophic cardiomyopathy and healthy cats (P < 0·001). Left atrial passive, active and complete ejection fraction distinguished between hypertrophic cardiomyopathy with congestive heart failure and asymptomatic hypertrophic cardiomyopathy (P < 0·001). Hypertrophic cardiomyopathy with congestive heart failure cats had significantly lower mitral A wave velocity (P = 0·016) and atrial complete emptying based on diameter and volume measurements (P = 0·008 and P < 0·001, respectively) compared with asymptomatic hypertrophic cardiomyopathy cats. Left atrial volume is obtainable by echocardiography in cats. Left atrial volume and atrial function may indicate chronicity and severity of diastolic dysfunction associated with hypertrophic cardiomyopathy and congestive heart failure. Left atrial function was reduced in cats with hypertrophic cardiomyopathy and congestive heart failure compared with healthy and asymptomatic hypertrophic cardiomyopathy groups.

Left atrial volume is superior to the ratio of the left atrium to aorta diameter for assessment of the severity of patent ductus arteriosus in extremely low birth weight infants.

This study was undertaken to establish the appropriate correction of left atrial volume (LAV) to body surface area (BSA) to provide reference values and to assess the hypotheses that LAV is useful for assessing patent ductus arteriosus (PDA) severity in extremely low birth weight infants (ELBWI) and could overcome the limitations of the LA-to-aortic dimension ratio (LA/Ao). Echocardiograms with 318 data points from 53 consecutive ELBWIs were assessed. PDA surgery was performed within the first 2 weeks in 6 patients. LAV was measured using the biplane (LAV) and single-plane (LAV(4CV)) area-length methods. The allometric model was used to correlate LAV to BSA. LAV(4CV) had a good correlation with LAV (R=0.93). Although LAV/BSA(1) had a residual relationship with BSA, LAV/BSA(1.54) (23.5±9.3 ml/m(3.08)) and LAV(4CV)/BSA(1.52) (21.4±9.4 ml/m(3.04)) did not. Receiver-operating characteristic analysis to detect hemodynamic status just before PDA surgery showed the superiority of LAV/BSA(1.54) (area under the curve (AUC) 0.97) and LAV(4CV)/BSA(1.52) (AUC 0.98) over LA/Ao (AUC 0.92). Moreover, LAV/BSA(1.54) and LAV(4CV)/BSA(1.52) were better correlated with left pulmonary arterial end-diastolic velocity than was LA/Ao. This study provided appropriate BSA correction of LAV and its reference values in ELBWIs. LAV indices may be superior to LA/Ao for PDA severity assessment. Measurement of single-plane LAV is easy, with similar usefulness to biplane LAV.

Echocardiographic image tracker with a speckle adaptive noise reduction filter for the automatic measurement of the left atrial volume curve

Since tracking accuracy in left atrial (LA) images decreases due to low image quality around the LA in the apical view, a practical tracking method for LA images has not yet been proposed. The aim of this study was to assess an accurate and high-speed LA volume tracking (LAVT) method for the automatic measurement of LA volume (LAV) curves. We used three approved protocols in this study: (i) LAV curves were measured by LAVT on computer-simulated images; (ii) in 20 healthy volunteers, we assessed the feasibility and accuracy of this method compared with expert's measurements; and (iii) echocardiography and multi-detector row computed tomography (MDCT) imaging were performed on the same day in 20 patients with suspected coronary artery disease. On computer-simulated images, mean absolute percentage LAVT error in one cardiac cycle was 3% in filtered images and 16% in original images. In 20 healthy volunteers, there are strong correlations between LAVT and the expert's LA measurements (LA maximum volume; R = 0.93, P < 0.001). In 400 LA images with 20 patients, an excellent correlation was obtained between LAVs using echocardiography and MDCT (R = 0.98, P < 0.001), with a small bias (-14% of the mean) and narrow limits of agreement (+15% of the mean). The mean time required for the LAVT analysis was 1.8 min, for the MDCT analysis was 35.8 min, and for the manual echocardiographic analysis was 14.0 min. This LAVT method is fast, valid, accurate, and reproducible for determining LAV in both simulated images and the clinical setting.

Measurement of Left and Right Atrial Volume in Patients Undergoing Ablation for Atrial Arrhythmias: Comparison of a Manual versus Semiautomatic Algorithm of Real Time 3D Echocardiography

Real time full-volume 3D echocardiography (3DE) allows rapid and noninvasive measurement of left (LA) and right atrial (RA) volume without geometric assumptions. Different algorithms from different commercial providers are available. Older software requires manual tracing of endocardial contours. Recently, software with semiautomatic endocardial contour-finding algorithms has become available, which considerably speeds up the procedure. Our aim was to compare, in the same dataset, both LA and RA volumes determined by an algorithm involving manual tracing to the corresponding volumes obtained by an algorithm with semiautomatic contour detection. Maximal atrial volumes were measured in 88 patients using a multiplane interpolation method algorithm based on manual planimetry of 8 slices. These volumes were compared with volumes determined by the QLAB 8.1 software using semiautomatic border detection. Linear regression showed excellent correlation between volumes determined by manual and by semiautomatic software for both LA and RA (r(2) = 0.90 and 0.89, respectively, P < 0.001). Bland-Altman analysis of manual versus semiautomatic volume determination showed narrow 95% limits of agreement (-15.9 to +12.0 mL for LA volume and -13.9 to +12.2 mL for RA volume) with a minimal bias of -1.9 ± 7.0 mL and -0.8 ± 6.5 mL, respectively, by the semiautomatic method. The semiautomatic border detection method shows excellent correlation for maximal LA and RA volume determination compared to the more time-consuming, multiplane interpolation method, with only slight underestimation. The results indicate that values of LA and RA volumes obtained by either algorithm can be compared, for example, during follow-up examinations.

Validation of Two‐Dimensional Methods for Left Atrial Volume Measurement: A Comparison of Echocardiography with Cardiac Computed Tomography

Left atrial volume (LAVol) is an important predictor of cardiovascular outcomes. Different formulas are applied to calculate LAVol using two-dimensional transthoracic echocardiography (2DTTE) with variable reference values. The objective of the study was to evaluate the accuracy of methods to calculate LAVol by 2DTTE or cardiac computed tomography (CT). Overall 177 consecutive patients who underwent both a 2DTTE and retrospective electrocardiogram (ECG)-gated coronary CT angiography (CTA) within 15days were included for this study. LA volume measurements were calculated by 2DTTE and 2DCT using the biplane area-length, biplane Simpson's, prolate-ellipsoid-1 and prolate-ellipsoid-2 methods. These results were compared with those measured by CT using a volumetric method. There was very good correlation between the CT and echocardiographic measures for LAVol, but significant underestimation of the echocardiographic methods when compared to the reference standard (33.5%, 39.1%, 48.1%, and 53.2% for the biplane area-length, biplane Simpson's, prolate-ellipsoid-1, and prolate-ellipsoid-2 methods, respectively). The biplane area-length method using 2DTTE had the closest volume estimation of all echocardiographic methods to the reference standard (67.6±25.5mL vs. 106±35.5mL, r=0.712). Similarly, the biplane area-length method using CT most accurately predicted LAVol (103.3±36.0mL, r=0.965). Compared to CT, 2DTTE provides reasonable assessment of LAVol, although all measurement methods underestimate LAVol. For both 2DTTE and CT, the biplane area-length method appears to provide the most accurate 2D estimate of LAVol.

Clinical utility and prognostic value of left atrial volume assessment by cardiovascular magnetic resonance in non‐ischaemic dilated cardiomyopathy

Echocardiographic studies have shown that left atrial volume (LAV) predicts adverse outcome in small heart failure (HF) cohorts of mixed aetiology. However, the prognostic value of LAV in non-ischaemic dilated cardiomyopathy (DCM) is unknown. Cardiovascular magnetic resonance (CMR) allows accurate and reproducible measurement of LAV. We sought to determine the long-term prognostic significance of LAV assessed by CMR in DCM. We measured LAV indexed to body surface area (LAVi) in 483 consecutive DCM patients referred for CMR. Patients were prospectively followed up for a primary endpoint of all-cause mortality or cardiac transplantation. During a median follow-up of 5.3 years, 75 patients died and 9 underwent cardiac transplantation. After adjustment for established risk factors, LAVi was an independent predictor of the primary endpoint [hazard ratio (HR) per 10 mL/m(2) 1.08; 95% confidence interval (CI) 1.01-1.15; P = 0.022]. LAVi was also independently associated with the secondary composite endpoints of cardiovascular mortality or cardiac transplantation (HR per 10 mL/m(2) 1.11; 95% CI 1.04-1.19; P = 0.003), and HF death, HF hospitalization, or cardiac transplantation (HR per 10 mL/m(2) 1.11; 95% CI 1.04-1.18; P = 0.001). The optimal LAVi cut-off value for predicting the primary endpoint was 72 mL/m(2). Patients with LAVi >72 mL/m(2) had a three-fold elevated risk of death or transplantation (HR 3.00; 95% CI 1.92-4.70; P < 0.001). LAVi provided incremental prognostic value for the prediction of transplant-free survival (net reclassification improvement 0.17; 95% CI 0.05-0.29; P = 0.002). LAVi is a powerful independent predictor of transplant-free survival and HF outcomes in DCM. Assessment of LAV improves risk stratification in DCM and should be incorporated into routine CMR examination.

Quantitative validation of left atrial structure and function by two-dimensional and three-dimensional speckle tracking echocardiography: A comparative study with three-dimensional computed tomography

BackgroundThe aim of this study was to validate the accuracy of three-dimensional (3D) speckle tracking echocardiography (STE) and two-dimensional (2D)-STE for the assessment of left atrial (LA) volume and function by comparison with 3D-computed tomography (CT) performed on the same day as STE. MethodsLA phasic volume and emptying function (EF) were measured in 28 patients with paroxysmal atrial fibrillation undergoing catheter ablation (62±11 years old) using both 3D-STE and 2D-STE during sinus rhythm. LA phasic volume and function measured by 3D-STE and 2D-STE were validated using 3D-CT as a gold standard. ResultsThe intraobserver correlation coefficient and variability in maximum LA volume assessed by 3D-STE were 0.99 and 1.4±6.0%, respectively. The interobserver correlation coefficient and variability in maximum LA volume assessed by 3D-STE were 0.99 and 0.2±4.5%, respectively. There were strong correlations between LA phasic volume measured by 3D-CT and those measured by 3D-STE (r=0.98, p<0.001). There were correlations between LA phasic function measured by 3D-CT and those measured by 3D-STE (r=0.85–0.88, p<0.001). There was a better agreement between 3D-CT and 3D-STE in the assessment of LA phasic volumes and function than between 3D-CT and 2D-STE in apical 2- and 4-chamber view. Conclusions3D-STE allows more accurate measurement of LA volume and function than 2D-STE and has high reproducibility.

Prognostic Value of Left Atrial Volume in Asymptomatic Organic Mitral Regurgitation

Basal left atrial volume (LAV) indexed to body surface area (LAVI) predicts adverse events in patients with organic mitral regurgitation, but information is lacking regarding change in left atrial volume during follow-up. One hundred forty-four asymptomatic patients (mean age, 71 ± 12 years; 66% women; mean ejection fraction, 66 ± 4.8%) with moderate to severe mitral regurgitation were prospectively included, with a median follow-up period of 2.76 years (interquartile range, 1.86-3.48 years). Fifty-four patients (37.50%) reached the combined end point of dyspnea and/or systolic dysfunction. Both basal and change in LAV were independently associated with the combined end point on multivariate analysis: for basal LAVI ≥ 55 mL/m(2), odds ratio, 2.26 (95% confidence interval, 1.04-4.88; P = .038), and for change in LAV ≥ 14 mL, odds ratio, 7.32 (95% confidence interval, 3.25-16.48; P < .001), adjusted for effective regurgitant orifice area and deceleration time. Combined event-free survival at 1, 2, and 3 years was significantly less in patients with basal LAVI ≥ 55 mL/m(2) (75%, 58%, and 43%) than in those with basal LAVI < 55 mL/m(2) (95%, 89%, and 77%) (log-rank test = 15.38, P = .0001). The incidence of the combined end point was highest (88%) in patients with basal LAVI ≥ 55 mL/m(2) and change in LAV ≥ 14 mL. Measurement of basal LAV and its increase during follow-up predict an adverse course in patients with moderate and severe asymptomatic mitral regurgitation. Hence, its assessment could be incorporated into the currently used algorithm for risk stratification and decision making in this group of patients.

Left atrial volume assessment by area-length method compared to multislice volumetric method using cardiovascular magnetic resonance imaging

Background Left atrial (LA) size is a strong predictor of cardiovascular events in patients with atrial fibrillation (AF) and a variety of other cardiovascular diseases. Left atrial volume (LAV) measurement is the preferred method for assessment of LA size. The most widely used technique for LAV assessment is the area-length (AL) method using 2D echocardiography. Studies have shown that AL method by echocardiography significantly underestimates LAV when compared with CMR using multislice volumetric (MSV) method. However, MSV method is time consuming due to increased acquisition and analysis time. We sought to compare LAV assessment by CMR using the more rapid AL method with MSV method. Methods We prospectively studied 273 patients with AF who underwent CMR on a 3T scanner (Siemens Trio). Image acquisition included SSFP cine of LA in short axis-stack, horizontal long-axis (4 chamber) and vertical long-axis (2 chamber) views. LAV by AL method was measured on CMR long axis views in end-systole as recommended by the American Society of Echocardiography. LAV by MSV method was performed by tracing the LA endocardial border on LA short axis stack in a phase with largest LA dimension. LA appendage and pulmonary veins were excluded by both methods. LAV and LAV index measurements by AL and MSV methods were compared using Pearson’s correlation, Regression analysis and Bland-Altman plots. Results CMR was successfully completed and analyzed in 252 patients; mean age 60.5 ± 10.7 years, 185 males (73.4%). Paroxysmal AF was the most common arrhythmia (57.5%). Mean CHA2DS2-VASc score was 1.7 ± 1.3. Coronary artery disease was present in 31 (12.3%), hypertension 154 (61.1%), heart failure 7 (2.8%), diabetes mellitus 34 (13.5%), TIA/CVA 18 (7.1%) and peripheral vascular disease in 7 (2.8%) patients. Mean heart rate during CMR was 68.7 ± 15.6 beats/ min, 82% were in sinus rhythm. Mean left ventricular EF was 58.6 ± 8.1% and right ventricular EF was 47 ± 7.2%. Table 1 shows the mean LAV and LAV index by AL and MSV methods and their correlation. LAV and LAV index by the AL method was significantly higher compared to MSV method (p <0.001 for both). AL method showed good correlation with MSV method. Bland-Altman plot showed mean measurement difference of 5.5 ± 10.5 ml/m 2 for LAV index between two methods. AL method tend to overestimate LAV index compared to MSV method by 26 ml/m 2 or underestimate by 14.9 ml/m 2 (Figure 1). Conclusions LA volume measurements by CMR AL method correlate well with the MSV method but limits of agreement are wide. These differences should be taken into account when using AL method for clinical or research purposes.

Left atrial volume quantification using cardiac MRI in atrial fibrillation: comparison of the Simpson’s method with biplane area-length, ellipse, and three-dimensional methods

Left atrial volume is an important predictor of future arrhythmias, and it can be assessed by several different methods. Simpson's method is well accepted as a reference standard, although no standardization exists for cardiac magnetic resonance (CMR). We aimed to compare the estimations of left atrial volumes obtained by the Simpson's method with three other methods. Eighty-one consecutive patients referred for CMR imaging between February 2007 and May 2010 were included in the study (47 males; mean age, 59.4±11.5 years; body mass index, 26.3±3.7 kg/m(2)). Left atrial volume measurements were performed using the Simpson's, biplane area-length, ellipse, and three-dimensional methods. Results were correlated using a Bland-Altman plot and linear regression models and compared by two-tailed paired-sample t tests. Reader variability was also calculated. Left atrial volume measurements using the biplane area-length technique showed the best correlation with Simpson's method (r=0.92; P < 0.001). Quantification values using the ellipse and three-dimensional methods were significantly different than values obtained using the Simpson's method (P < 0.05, for both). All methods showed excellent observer reliability (intra-class correlation coefficient >0.99). The biplane area-length method can be used for left atrial volume measurement when the Simpson's method cannot be performed. If these two methods are not feasible, then all methods are highly reproducible and can be used, but should not be used interchangeably for follow-up studies.

Assessment of ST‐Elevation Myocardial Infarction–Related Diastolic Dysfunction with Compensatory Rise in Left Atrial Ejection Force

It is well known that patients with ST-elevation myocardial infarction (STEMI) show both systolic and diastolic left ventricular dysfunction. The aim of this study was to assess post-myocardial infarction diastolic dysfunction using left atrial ejection force (LAEF) in patients treated with primary percutaneous coronary intervention (PCI). We enrolled 58 patients presenting with STEMI who were treated with primary PCI and 23 healthy subjects as a control group. A detailed transthoracic echocardiogram, including mitral flow velocities, tissue Doppler mitral annular velocities, and left atrial (LA) phasic volumes, was performed in both groups. We also measured the level of B-type natriuretic peptide (BNP). LAEF was calculated using the formula: 0.5×P×Mitral orifice area×(Peak A velocity)(2) . Correlations between variables were studied using "Pearson and Spearman's rho" test. In the test group, we found that the level of BNP in the plasma, E/E' ratio, and the LA volume measurements were higher than that of the control group, and those differences were statistically significant. LAEF was increased in patients with myocardial infarction (MI); moderately correlated to BNP (r=0.383 and P=0.001) and E/E' (r=0.473 and P=0.001), and strongly correlated to A-wave velocity (r=0.731 and P=0.001). LAEF was also negatively correlated to E/A ratio (r=-0.419 and P=0.001) and LVEF (r=-0.339 and P=0.003). Impaired diastolic function in STEMI affects LA and increased LAEF is one of its manifestations. LAEF may also have diagnostic importance in diastolic dysfunction, but these findings should be confirmed by further studies.

Abstract 9638: Left Atrial Volume Provides Independent and Incremental Prognostic Information in Non-Ischemic Dilated Cardiomyopathy

Introduction: Echo data have shown that left atrial (LA) diameter and area predict adverse outcome in heart failure (HF) cohorts of mixed etiology. Since LA dilatation is asymmetric, LA volume (LAV) is a better measure of LA size. CMR allows more accurate measurement of LAV due to its superior spatial resolution and endocardial border definition. We hypothesized that CMR assessment of LAV provides independent and incremental prognostic information in non-ischemic dilated cardiomyopathy (DCM). Methods: Consecutive patients with DCM referred for CMR between 2000-08 were prospectively enrolled. Patients with IHD, primary valvar disease and infiltrative CM were excluded. LAV was measured at LV end-systole by a single blinded specialist using the biplane area-length method and indexed to body surface area (LAVi). The primary endpoint was cardiovascular (CV) death or cardiac transplantation (CTx). The secondary endpoint was a composite of HF death, HF hospitalization or CTx. Results: In total 483 patients (327 male, mean age 51 yrs, mean LVEF 37%) were followed up for a median duration of 64 months. There were 75 deaths (60 CV deaths) and 9 patients underwent CTx. ROC analysis identified that the optimal LAVi cut-off value for predicting the primary endpoint was 77 ml/m 2 . Kaplan-Meier analysis demonstrated that patients with a LAVi&gt;77 ml/m 2 had a significantly higher rate of CV death or CTx (p&lt;0.001, Fig.1). After stepwise Cox regression multivariate analysis, LAVi remained a significant independent predictor of CV death or CTx (HR per 10 ml/m 2 , 1.11, 95% CI 1.04 to 1.19; p=0.003) and the secondary HF composite (HR per 10 ml/m 2 , 1.11, 95% CI 1.04 to 1.18; p=0.001), alongside conventional prognosticators such as LVEF and NYHA class. Conclusions: LAV has independent and incremental prognostic value for the prediction of transplant-free CV survival and HF outcomes in DCM. Assessment of LAV improves risk stratification in DCM and should be incorporated into routine CMR examination.

Measurement of Left Atrial Volume from Transthoracic Three-Dimensional Echocardiographic Datasets Using the Biplane Simpson’s Technique

Although left atrial volume (LAV) by two-dimensional (2D) echocardiography provides prognostic information, the misalignment of the 2D cutting plane of the left atrium could make the measurements inaccurate. The aim of this study was to test the hypothesis that LAV measurement from three-dimensional (3D) echocardiographic data sets using the biplane Simpson's technique is a more reliable approach for measuring LAV. The accuracy of 3D echocardiographic LAV measurements was retrospectively determined in 20 patients using multidetector computed tomography as a reference. LAV indexed to body surface area (LAVI) was measured using 2D and 3D echocardiography in 200 other subjects. LAV determination by 2D echocardiography was performed using the biplane Simpson's method. A 3D determination of LAV was performed using quantitative software and the biplane Simpson's method using the anterior-posterior and medial-lateral 2D views extracted from the 3D data sets. Although LAV using the 3D volumetric method (mean, 98 ± 24 mL) was slightly but significantly lower than LAV on multidetector computed tomography (mean, 103 ± 23 mL), a significant correlation between the two methods (r= 0.97, P < .001) with acceptable limits of agreement was noted. The left atrial short-axis image extracted from the 3D data sets revealed an ellipsoid shape. Although a good correlation for LAVI was noted between the 2D biplane Simpson's method and the 3D volumetric method (r= 0.96, P < .001), the mean value of 2D echocardiographic LAVI was significantly greater compared with 3D echocardiographic LAVI, with a mean bias of 4.7 mL/m(2). An excellent correlation was noted between the 3D biplane Simpson's and 3D volumetric methods (r= 0.99, P < .001), with a lower bias (0.54 mL/m(2)) and limits of agreement of ±5.8 mL/m(2). The time required for LAV analysis was significantly shorter with the 2D (mean, 82 ± 7 sec) and 3D (mean,94±11 sec) biplane Simpson's methods (P < .01 vs 2D biplane Simpson's method) compared with the 3D volumetric methods (mean, 135 ± 24 sec) (P < .01 vs 2D and 3D biplane Simpson's methods). The 2D biplane Simpson's method overestimates LAV because of the misalignment of the 2D cutting plane, and the 3D biplane Simpson's method is a practical and more reliable way to accurately determine LAV.

Real-Time 3D Echocardiographic Quantification of Left Atrial Volume: Multicenter Study for Validation With CMR

We studied in a multicenter setting the accuracy and reproducibility of 3-dimensional echocardiography (3DE)-derived measurements of left atrial volume (LAV) using new, dedicated volumetric software, side by side with 2-dimensional echocardiography (2DE), using cardiac magnetic resonance (CMR) imaging as a reference. Increased LAV is associated with adverse cardiovascular outcomes. Although LAV measurements are routinely performed using 2DE, this methodology is limited because it is view dependent and relies on geometric assumptions regarding left atrial shape. Real-time 3DE is free of these limitations and accordingly is an attractive alternative for the evaluation of LAV. However, few studies have validated 3DE-derived LAV measurements against an accepted independent reference standard, such as CMR imaging. We studied 92 patients with a wide range of LAV who underwent CMR (1.5-T) and echocardiographic imaging on the same day. Images were analyzed to obtain maximal and minimal LAV: CMR images using standard commercial tools, 2DE images using a biplane area-length technique, and 3DE images using Tomtec LA Function software. Intertechnique comparisons included linear regression and Bland-Altman analyses. Reproducibility of all 3 techniques was assessed by calculating the percentage of absolute differences in blinded repeated measurements. Kappa statistics were used to compare 2DE and 3DE classification of normal/enlarged against the CMR reference. 3DE-derived LAV values showed higher correlation with CMR than 2DE measurements (r = 0.93 vs. r = 0.74 for maximal LAV; r = 0.88 vs. r = 0.82 for minimal LAV). Although 2DE underestimated maximal LAV by 31 ± 25 ml and minimal LAV by 16 ± 32 ml, 3DE resulted in a minimal bias of -1 ± 14 ml for maximal LAV and 0 ± 21 ml for minimal LAV. Interobserver and intraobserver variability of 2DE and 3DE measurements of maximal LAV were similar (7% to 12%) and approximately 2 times higher than CMR (4% to 5%). 3DE classified enlarged atria more accurately than 2DE (kappa: 0.88 vs. 0.71). Compared with CMR reference, 3DE-derived LAV measurements are more accurate than 2DE-based analysis, resulting in fewer patients with undetected atrial enlargement.

Diastolic function parameters are improved by the addition of simvastatin to enalapril-based treatment in hypertensive individuals

ObjectiveDiastolic dysfunction (DD) is a frequent condition in hypertensive patients whose presence increases mortality and whose treatment remains unclear. The aim of this study was to investigate in a prospective, double-blinded, placebo-controlled randomized design the additive effect of simvastatin on DD in enalapril-treated hypertensive patients with average cholesterol levels. MethodsHypertensive patients with DD and LDL-cholesterol <160mg/dL underwent a run-in phase to achieve a systolic blood pressure (SBP) <135mmHg and diastolic blood pressure (DBP) <85mmHg with enalapril. Hydrochlorothiazide was added when need to achieve blood pressure control. Four weeks after reaching the optimum anti-hypertensive regimen patients were randomized to receive 80mg simvastatin (n=27) or placebo (n=28) for a period of 20 weeks. Echocardiograms were performed before and after treatment with measurement of maximum left atrial volume (LAV), conventional and tissue Doppler velocities in early diastole (E, e′) and late diastole (A, a′). ResultsAfter 20 weeks, the simvastatin group presented reduction in SBP (−4±2mmHg, p=0.02), increase in E/A ratio (1.0±0.05 to 1.2±0.06, p=0.03) and decrease of LAV indexed to body surface area (24.5±0.9 to 21.1±0.8ml/m2, p=0.048), as compared with placebo arm. No change in systolic function and no correlation between the E/A ratio, LAV and changes in blood pressure or lipid profile were observed. ConclusionsThe addition of simvastatin to enalapril in hypertensive patients with average cholesterol levels improves parameters of diastolic function independently of changes in blood pressure or cholesterol.

LEFT ATRIAL AREA STRAIN MEASURED BY THREE DIMENSIONAL SPECKLE TRACKING ECHOCARDIOGRAPHY REPRESENTS GLOBAL AND REGIONAL LEFT ATRIAL FUNCTION AT ONCE

Measurements of left atrial volume and function has become clinically important in aging society. Feasibility and reliability of a novel automatic indexbased on internal surface area change (AS :area strain) of left atrium using three dimensional speckle tracking echocardiography (3DSTE) was

Left atrial volume measurements before and after left atrial ablation for the treatment of atrial fibrillation

The aim of this study was to evaluate left atrial (LA) volume measurements using cardiac magnetic resonance (CMR) based angiography before and after LA radio frequency (RF) ablation therapy as a treatment strategy for atrial fibrillation (AFIB).

Core Lab Analysis of Baseline Echocardiographic Studies in the STICH Trial and Recommendation for Use of Echocardiography in Future Clinical Trials

The Surgical Treatment for Ischemic Heart Failure (STICH) randomized trial was designed to identify an optimal management strategy for patients with ischemic cardiomyopathy. Baseline echocardiographic examinations were required for all patients. The primary aim of this report is to describe the baseline STICH Echocardiography Core Laboratory data. The secondary aim is to provide recommendations regarding how echocardiography should be used in clinical practice and research on the basis of the experience gained from echocardiography in STICH. Between September 2002 and January 2006, 2,136 patients with ejection fractions (EFs) ≤ 35% and coronary artery disease amenable to coronary artery bypass grafting were enrolled. Echocardiography was acquired by 122 clinical enrolling sites, and measurements were performed by the Echocardiography Core Laboratory after a certification process for all clinical sites. Echocardiography was available for analysis in 2,006 patients (93.9%); 1,734 (86.4%) were men, and the mean age was 60.9 ± 9.5 years. The mean left ventricular end-systolic volume index, measureable in 72.8%, was 84.0 ± 30.9 mL/m(2), and the mean EF was 28.9 ± 8.3%, with 18.5% of patients having EFs > 35%. Single-plane measurements of left ventricular and left atrial volumes were similar to their volumes by biplane measurement (r= 0.97 and r= 0.92, respectively). Mitral regurgitation severity by visual assessment was associated with a wide range of effective regurgitant orifice area, while effective regurgitant orifice area ≥ 0.2 cm(2) indicated at least moderate mitral regurgitation by visual assessment. Deceleration time of mitral inflow velocity had a weak correlation with EF (r= 0.25) but was inversely related to estimated pulmonary artery systolic pressure (r= -0.49). In STICH patients with ischemic cardiomyopathy, Echocardiography Core Laboratory analysis of baseline echocardiographic findings demonstrated a wide spectrum of left ventricular shape, function, and hemodynamics, as well as the feasibility and limitations of obtaining essential echocardiographic measurements. It is critical that the use of echocardiographic parameters in clinical practice and research balance the strengths and weaknesses of the technique.

Prediction of Left Atrial Fibrosis With Speckle Tracking Echocardiography in Mitral Valve Disease: A Comparative Study With Histopathology

Background and ObjectivesLeft atrial (LA) fibrosis is a main determinant of LA remodeling and development of atrial fibrillation. However, non-invasive prediction of LA fibrosis is challenging. We investigated whether preoperative LA strain as measured by speckle tracking echocardiography could predict the degree of LA fibrosis and LA reverse remodeling after mitral valve (MV) surgery.Subjects and MethodsSpeckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery. LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured. LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39).ResultsLeft atrial global strain was significantly correlated with the degree of LA fibrosis (r=-0.55, p<0.001), and its correlation was independent of age, underlying rhythm, presence of rheumatic heart disease and type of predominant MV disease (B=-1.37, 95% confidence interval -2.32 - -0.41, p=0.006). The degree of LA fibrosis was significantly correlated with early (r=-0.337, p=0.017) and 1-year (r=-0.477, p=0.002) percent LA volume reduction after MV surgery, but LA global strain was not significant.ConclusionLeft atrial strain as measured by speckle tracking echocardiography might be helpful for predicting the degree of LA fibrosis in patients with MV disease.