Assessment of Echocardiographic Left Atrial Size: Accuracy of M-Mode and Two-Dimensional Methods and Prediction of Diastolic Dysfunction

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 29; no. 4; pp. 379 - 384
• Main Authors: Stefano, Gregory T., Zhao, Hong, Schluchter, Mark, Hoit, Brian D.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-04-2012
• Subjects: Algorithms; diastolic dysfunction; Echocardiography - methods; Female; Heart Atria - diagnostic imaging; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; left atrial volume; Male; Middle Aged; Organ Size; Reproducibility of Results; Sensitivity and Specificity; Stroke Volume; Ventricular Dysfunction, Left - diagnostic imaging
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/j.1540-8175.2011.01643.x

Background: Despite the American Society of Echocardiography recommendation to use left atrial volume indexed for body surface area (LAVI) for quantification of left atrial size, a variety of methods are used in clinical practice. Our objectives were to evaluate the accuracy of M‐mode and two‐dimensional (2D) echocardiographic LA size estimates to LAVI and to determine their ability to predict left ventricular diastolic dysfunction. Methods: In 150 consecutive patients, LA diameter (LAD), LA diameter indexed for body surface area (LADI), LA area in the apical two‐ and four‐chamber views (LAA 2c and LAA 4c), biplane area–length LA volume (LAV), and LAVI were obtained. The accuracy of these methods to quantify LA enlargement by LAVI, correlation with clinical parameters, and ability to act as a surrogate for diastolic dysfunction were determined using Pearson correlation coefficients along with univariate and multiple logistic analysis. Results: The true degree of LA size (with LAVI as standard) was identified by LAD in 45%, LADI in 42%, LAA 4c in 43%, and LAA 2c in 41%. All methods showed positive correlation with age, E/E′, mitral regurgitation, and right atrial size and negative correlation with ejection fraction. LAVI was the strongest method to predict any (c = 0.655, P = 0.012) or moderate–severe (P = 0.856 and P < 0.001) diastolic dysfunction. All methods have greater capacity to identify moderate or severe diastolic dysfunction than any degree of diastolic dysfunction alone. Conclusions: One‐dimensional and 2D methods inaccurately quantify LA size and are inferior to LAVI to predict diastolic dysfunction. (Echocardiography 2012;29:379‐384)