Method
Relation of Left Atrial Maximal Volume Measured by Real-Time 3D Echocardiography to Demographic, Clinical, and Doppler Variables

https://doi.org/10.1016/j.amjcard.2008.01.005Get rights and content

Left atrial (LA) enlargement is a negative prognostic factor for survival in patients with stroke, congestive heart failure, and myocardial infarction. In the absence of mitral valvular disease it is also a marker of chronic elevated left ventricular filling pressures. The aim of our study was to examine whether the currently considered factors such as demographic, clinical, and Doppler parameters fully correspond to LA maximal volume measured by real time three-dimensional echocardiography (RT3DE). Two-hundred-twenty-four patients (age 58 ± 12 years) were studied. Of these, 66 were healthy volunteers and 158 were patients with more than 2 cardiovascular risk factors (109), documented coronary heart disease (CHD) and normal LV function (33), and patients with (10) and without (6) IHD and LV systolic dysfunction. Two-dimensional Doppler and tissue Doppler (TDI) echocardiographic parameters and LA maximal volume, assessed by RT3DE were analyzed. LA maximal volume values were positively and highly significantly associated, after adjustment for age and sex, with LV mass, mitral flow peak E velocity and E/A ratio, TDI E′/A′ ratio and E/e′ ratio (P < 0.001). There were highly significant inverse associations of LA maximal volume and ejection fraciton and peak A′ velocity detected by TDI (P < 0.0001). LA maximal volume was significantly correlated with the progression of diastolic dysfunction from normal to grade III. In particular, there was a clear difference between the normal and pseudonormal filling patterns (p < 0.001) in terms of LA maximal volume. In conclusion, progressive LA volume increase is directly correlated with age, LV mass, and LV diastolic dysfunction, and inversely correlated with LV systolic function.

Section snippets

Methods

After approval by the institutional review board, selected healthy volunteers and consecutive out- and in-patients referred to La Sapienza University Hospital of Rome, Italy, for an elective echocardiographic study were examined. All patients gave their written informed consent. General exclusion criteria were any of atrial fibrillation, poor echocardiographic acoustic window, or moderate/severe mitral or aortic valve disease.

A cardiologist carried out a complete history and clinical

Results

The initial study population was 238 patients, 66 healthy volunteers and 172 consecutive patients referred to the echocardiography laboratory for various cardiovascular disorders. Of the latter, 14 were excluded because of suboptimal LA endocardial border definition (n = 7), frequent premature supraventricular beats (n = 5), and imaging artifacts (n = 2).

On the basis of clinical history, physical examination, and instrumental data, the 224 patients were classified into 4 subgroups of 66 healthy

Discussion

We found that clinical, demographic, and 2D Doppler echocardiographic parameters had high correlation with the presence of increased LA volume detected using RT3DE. Ageing was associated with progressive enlargement and then volume of the left atrium because of decreased LV diastolic function caused by prolonged LV relaxation and impairment of LV passive properties. This was also shown by the analysis of transmitral flow patterns, detected using pulse-wave Doppler, in which there was a

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