TY - JOUR
T1 - Left atrial remodelling in mitral regurgitation - Methodologic approach, physiological determinants, and outcome implications
T2 - A prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study
AU - Messika-Zeitoun, David
AU - Bellamy, Michael
AU - Avierinos, Jean Francois
AU - Breen, Jerome
AU - Eusemann, Christian
AU - Rossi, Andrea
AU - Behrenbeck, Thomas
AU - Scott, Christopher
AU - Tajik, Jamil A.
AU - Enriquez-Sarano, Maurice
PY - 2007/6
Y1 - 2007/6
N2 - Aims: To define accurate and normal range of echocardiographic left atrial (LA) volume measurement and to assess the prevalence, determinants, and outcome implications of LA enlargement in mitral regurgitation (MR). Methods and results: We prospectively compared LA volume obtained simultaneously by electron beam-computed tomography (EBCT) and by four echocardiographic methods in 33 test patients. Accurate echocardiographic LA volume measurements were obtained only by biplane area-length method with vertical longitudinal-length (r = 0.95, P < 0.0001; 145 ± 57 vs. 143 ± 55 mL, P = 0.57). Using this method, the normal range in 100 normal subjects, the physiological determinants and outcome implications of LA enlargement in 320 patients with organic MR were analysed. In normal subjects, indexed to body surface area, LA index (27 ± 6 mL/m2) was not influenced by age or gender and values ≥ 40 mL/m2 were beyond the upper limit of normal. In MR, the most powerful determinants of LA enlargement were higher regurgitant volume (RVol) and atrial fibrillation (AF) (P < 0.0001), followed by older age, female gender, higher left ventricular end-systolic volume, and mass (all P < 0.001). After diagnosis in sinus rhythm, LA index ≥ 40 mL/m2 predicted superiorly and independently to LA diameter the occurrence of AF [adjusted RR 1.48 (1.06-2.16), P < 0.01] and the combined endpoint of death or need for mitral surgery [adjusted RR 1.61 (1.3-2.0), P < 0.0001]. Conclusion: LA remodelling can be accurately assessed by echocardiography and LA index ≥ 40 mL/m2 is beyond the normal range. In organic MR, higher LA index is the combined result of multiple physiological effects, provides independent prognostic information, and therefore should be part of a comprehensive echocardiographic examination.
AB - Aims: To define accurate and normal range of echocardiographic left atrial (LA) volume measurement and to assess the prevalence, determinants, and outcome implications of LA enlargement in mitral regurgitation (MR). Methods and results: We prospectively compared LA volume obtained simultaneously by electron beam-computed tomography (EBCT) and by four echocardiographic methods in 33 test patients. Accurate echocardiographic LA volume measurements were obtained only by biplane area-length method with vertical longitudinal-length (r = 0.95, P < 0.0001; 145 ± 57 vs. 143 ± 55 mL, P = 0.57). Using this method, the normal range in 100 normal subjects, the physiological determinants and outcome implications of LA enlargement in 320 patients with organic MR were analysed. In normal subjects, indexed to body surface area, LA index (27 ± 6 mL/m2) was not influenced by age or gender and values ≥ 40 mL/m2 were beyond the upper limit of normal. In MR, the most powerful determinants of LA enlargement were higher regurgitant volume (RVol) and atrial fibrillation (AF) (P < 0.0001), followed by older age, female gender, higher left ventricular end-systolic volume, and mass (all P < 0.001). After diagnosis in sinus rhythm, LA index ≥ 40 mL/m2 predicted superiorly and independently to LA diameter the occurrence of AF [adjusted RR 1.48 (1.06-2.16), P < 0.01] and the combined endpoint of death or need for mitral surgery [adjusted RR 1.61 (1.3-2.0), P < 0.0001]. Conclusion: LA remodelling can be accurately assessed by echocardiography and LA index ≥ 40 mL/m2 is beyond the normal range. In organic MR, higher LA index is the combined result of multiple physiological effects, provides independent prognostic information, and therefore should be part of a comprehensive echocardiographic examination.
KW - Atrium
KW - Computed tomography
KW - Echocardiography
KW - Mitral valve
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=34547737978&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34547737978&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehm199
DO - 10.1093/eurheartj/ehm199
M3 - Article
C2 - 17562673
AN - SCOPUS:34547737978
SN - 0195-668X
VL - 28
SP - 1773
EP - 1781
JO - European heart journal
JF - European heart journal
IS - 14
ER -