Real three-dimensional assessment of left atrial and left atrial appendage volumes by 64-slice spiral computed tomography in individuals with or without cardiovascular disease
Introduction
Left atrial (LA) size has been shown to be a marker of diastolic dysfunction and is related to cardiovascular morbidity in various cardiovascular diseases (CD) [1], [2], [3], [4], [5], [6]. An alteration in LA size may imply the progression of cardiac disease and LA volume appears as a more robust marker of adverse events than LA diameter or area [7]. Left atrial enlargement is usually measured using M-mode or bi-dimensional trans-thoracic echocardiography (TTE) [1], [8], [9]. The association of multislice computed tomography (MSCT) imaging and new 3D reconstruction software, allows direct left atrial or ventricular volume measurements without geometrical assumptions [10], [11], [12], [13], [14]. In the present study the maximal (LAmax) and minimal (LAmin) LA volume during the cardiac cycle, and the left atrial appendage volume (LAA), were obtained by MSCT in patients without cardiovascular disease and in patients with either severe mitral regurgitation (MR), coronary artery disease (CAD), left ventricular hypertrophy (LVH) or idiopathic dilated cardiomyopathy (DCM).
Section snippets
Study design and population
We have prospectively selected individuals from a cohort of patients scheduled for have a non-invasive coronary imaging using an ECG-gated 64-MSCT scanner between February 1, 2006 and March 30, 2007 in our Institution. The indication and the realization of MSCT imaging were in acceptance with the Institutional guidelines. MSCT exclusion criteria included age < 18 years, allergy to iodinated contrast, renal insufficiency (serum creatinine > 1.5 mg/dl), pregnancy, irregular heart rate, calcium score
Statistical analysis
Statistical analysis was performed using the Statview V.5 software (SAS Institute, Cary, NC, USA). Continuous variables were expressed as mean ± standard deviation (SD). Categorical variables were reported as percentages. Continuous data were compared between “Normal” and other groups using Mann–Whitney test. Categorical data were compared between groups using the chi-square test. Univariate associations of continuous clinical variables and MSCT variables were calculated using Spearman
Results
Three-dimensional reconstruction of LA and LAA is shown in Fig. 1. The post processing time for LA and LAA volumes measurements was 16 ± 4 min.
Discussion
This study has 3 major findings. First, this study showed feasibility of MSCT imaging with cardiac cycle gating and commercially available 3D reconstruction software in the detection of cyclic changes in LA and LAA volumes. Measurements were performed from a standardized coronary computed tomographic angiography protocol, without additional injection or radiation exposure. Second, the normal MSCT values for LAmax, LAmin, LAEF, LAEV, LAAmax and LAAmin, including the upper limits of normal were
Study limitations
Our study has some limitations. The sample size limitations may have precluded discerning small differences in LA volume and function between patients with or without cardiovascular disease and in the different subgroups of patients. Because of the radiation exposure, the inclusion of normal volunteers to constitute the Normal group was not possible. Thus, we have carefully selected individuals without history of cardiovascular disease and with normal transthoracic echocardiography for the
Conclusion
Our results underline that maximal and cyclic changes of left atrial and left atrial appendage volumes might be evaluated from the dataset of conventional contrast enhanced MSCT coronary angiography with cardiac gating. The left atrial anatomic differences between individuals with or without cardiovascular disease in normal sinus rhythm might be also assessed, without additional contrast media infusion or radiation exposure. These measurements have to be taken into account to improve the risk
Acknowledgement
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [41].
References (41)
- et al.
Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women
Mayo Clinic Proc
(2001) - et al.
Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: the Strong Heart Study (SHS)
Am Heart J
(2006) - et al.
Usefulness of left atrial size in predicting postoperative symptomatic improvement in patients with aortic stenosis
Am J Cardiol
(2000) - et al.
Prognostic value of left atrial enlargement in patients with idiopathic dilated cardiomyopathy and ischemic cardiomyopathy
Am J Cardiol
(2002) - et al.
Long-term prognosis significance of left atrial volume in acute myocardial infarction
J Am Coll Cardiol
(2004) - et al.
Prediction of cardiovascular outcomes with left atrial size. Is volume superior to area or diameter?
J Am Coll Cardiol
(2006) - et al.
Usefulness of left atrial volume in predicting first congestive heart failure in patients ≥ 65 years of age with well-preserved left ventricular systolic function
Am J Cardiol
(2005) - et al.
Best method in clinical practice and in research studies to determine left atrial size
Am J Cardiol
(1999) - et al.
Estimation of global and regional cardiac function using 64-slice computed tomography: a comparison study with echocardiography, gated-SPECT and cardiovascular magnetic resonance
Int J Cardiol
(2008) - et al.
Quantitative 4-dimensional volumetric analysis of left ventricle in ischemic heart disease by 4-slice computed tomography: a comparative study with invasive left ventriculogram
Int J Cardiol
(2008)
Computed tomography coronary angiography
J Am Coll Cardiol
Atrial volume in a normal adult population by two-dimensional echocardiography
Chest
Left atrial volume determination by biplane two-dimensional echocardiography: validation with cine computed tomography
Am Heart J
Comparison of left atrial volume by 2 dimensional echocardiography and cine-computed tomography
Am J Cardiol
Effects of left atrial ablation of atrial fibrillation on size of the left atrium and pulmonary veins
Heart Rhythm
Characterization of left atrium and distal pulmonary vein morphology using multidimensional computed tomography
J Am Coll Cardiol
Simple single-section method for measurement of left and right atrial volumes with electron-beam CT
Acad Radiol
Left atrial size. Physiologic determinants and clinical applications
J Am Coll Cardiol
In vivo analysis of the anatomical relationship of coronary sinus to mitral annulus and left circumflex coronary artery using cardiac multidetector computed tomography. Implications for percutaneous coronary sinus mitral annuloplasty
J Am Coll Cardiol
Anatomical remodelling of left atria in subjects with chronic and paroxysmal atrial fibrillation evaluated by multislice computed tomography
Int J Cardiol
Cited by (35)
Left atrial appendage segmentation from 3D CCTA images for occluder placement procedure
2019, Computers in Biology and MedicineLeft atrial volume assessed by ECG-gated computed tomography: Variations according to age, gender and time during the cardiac cycle
2018, Diagnostic and Interventional ImagingCitation Excerpt :We did not compare our CT measurements to MRI. However, this work has been already done; at the 40% period of the RR cycle, normal value varies between 54 ± 10 mL/m2 [13], study done using CT) and 50 ± 6 mL/m2 [14], study done using MRI). These results are similar to ours and show that MDCT can be as accurate as MRI to estimate cardiac volume as previously demonstrated [15].
Right ventricular dysfunction and dilatation in patients with mitral regurgitation: Analysis using ECG-gated multidetector row computed tomography
2013, International Journal of CardiologyCitation Excerpt :Advances in sixty-four slice multidetector row CT (64-MDCT) technology have increased the feasibility of noninvasive coronary angiography and the comprehensive evaluation of cardiac function and anatomic characteristics with high temporal resolution using a multisector reconstruction algorithm [8,9]. Sixty-four to 320 slice computed tomography may assist in the evaluation of atrial volume and function index [10–14]. Furthermore, 16- and 64-MDCT scans accurately assess valvular diseases and function using the same data set that is acquired for the evaluation of coronary arteries [15,16].
Assessment of the structural remodeling of the left atrium by 64-multislice cardiac CT: Comparative studies in controls and patients with atrial fibrillation
2012, International Journal of CardiologyCitation Excerpt :In addition, the function of the LA is attracting a great deal of interest in these patients because the volume and function of the LA are known to be independent parameters that can predict the success of RFA [9]. Previous studies have generally assessed the function of the left atrial proper or the left atrial appendage (LAA) separately [10–13]. Recently, LA volume quantification with cardiac MDCT has been challenged in controls and AF patients, and a few recent reports have demonstrated a close correlation between cardiac CT and echocardiography [11,14–16].
Low dose 320-row CT for left atrium and pulmonary veins imaging - The feasibility study
2012, European Journal of Radiology