CLINICAL RESEARCH: ECHOCARDIOGRAPHY
Prediction of Cardiovascular Outcomes With Left Atrial Size
Is Volume Superior to Area or Diameter?
Teresa S.M. Tsang, MD, FACC*, ,*,
Walter P. Abhayaratna, MBBS, FRACP*,,
Marion E. Barnes, MS,
Yoko Miyasaka, MD, PhD, FACC*,,
Bernard J. Gersh, MB, ChB, DPhiL, FACC*,
Kent R. Bailey, PhD ,
Stephen S. Cha, MS and
James B. Seward, MD, FACC*,
* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
Mayo Echocardiography Research Center, Mayo Clinic, Rochester, Minnesota
Section of Biostatistics, Mayo Clinic, Rochester, Minnesota
Manuscript received May 9, 2005;
revised manuscript received August 3, 2005,
accepted August 9, 2005.
* Reprint requests and correspondence: Dr. Teresa S. M. Tsang, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: tsang.teresa{at}mayo.edu).
OBJECTIVES: We sought to compare left atrial (LA) volume to LA area and diameter for the prediction of adverse cardiovascular outcomes.
BACKGROUND: The incremental value of LA volume compared with LA area or diameter as a cardiovascular risk marker has not been evaluated prospectively for patients with sinus rhythm or atrial fibrillation (AF).
METHODS: Left atrial size was assessed with biplane LA volume, four-chamber LA area, and M-mode dimension for 423 patients (mean age 71 ± 8 years, 56% men) who were prospectively followed for development of first AF, congestive heart failure, stroke, transient ischemic attack, myocardial infarction, coronary revascularization, and cardiovascular death.
RESULTS: Of the 317 subjects in sinus rhythm at baseline, 62 had 90 new events during a mean follow-up of 3.5 ± 2.3 years. All three LA size parameters were independently predictive of combined outcomes (all p < 0.0001). The overall performance for the prediction of cardiovascular events was greatest for LA volume (area under the receiver operator characteristic curve: indexed LA volume 0.71; LA area 0.64; LA diameter 0.59). A graded association between the degree of LA enlargement and risk of cardiovascular events was only evident for indexed LA volume. For subjects with AF, there was no association between LA size and cardiovascular events.
CONCLUSIONS: Left atrial volume is a more robust marker of cardiovascular events than LA area or diameter in subjects with sinus rhythm. The predictive utility of LA size for cardiovascular events in AF was poor, irrespective of the method of LA size quantitation.
|
Abbreviations and Acronyms
| | AF = atrial fibrillation | | CHF = congestive heart failure | | LA = left atrial | | LV = left ventricular | | MI = myocardial infarction | | TIA = transient ischemic attack |
|
This article has been cited by other articles:
|
|
|
|
 
P. Caso, R. Ancona, G. Di Salvo, S. Comenale Pinto, M. Macrino, V. Di Palma, A. D'Andrea, A.R. Martiniello, S. Severino, and R. Calabro
Atrial reservoir function by strain rate imaging in asymptomatic mitral stenosis: prognostic value at 3 year follow-up
Eur J Echocardiogr,
August 1, 2009;
10(6):
753 - 759.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T K Lim, G Dwivedi, S Hayat, S Majumdar, and R Senior
Independent value of left atrial volume index for the prediction of mortality in patients with suspected heart failure referred from the community
Heart,
July 15, 2009;
95(14):
1172 - 1178.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. P. Aurigemma, J. S. Gottdiener, A. M. Arnold, M. Chinali, J. C. Hill, and D. Kitzman
Left Atrial Volume and Geometry in Healthy Aging: The Cardiovascular Health Study
Circ Cardiovasc Imaging,
July 1, 2009;
2(4):
282 - 289.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Conen, U. B. Tedrow, B. A. Koplan, R. J. Glynn, J. E. Buring, and C. M. Albert
Influence of Systolic and Diastolic Blood Pressure on the Risk of Incident Atrial Fibrillation in Women
Circulation,
April 28, 2009;
119(16):
2146 - 2152.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Yoshida, S. Nakao, A. Goda, Y. Naito, M. Matsumoto, M. Otsuka, M. Shimoshikiryo, A. Eguchi, M. Lee-Kawabata, T. Tsujino, et al.
Value of assessment of left atrial volume and diameter in patients with heart failure but with normal left ventricular ejection fraction and mitral flow velocity pattern
Eur J Echocardiogr,
March 1, 2009;
10(2):
278 - 281.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Fatema, K. R. Bailey, G. W. Petty, I. Meissner, M. Osranek, A. A. Alsaileek, B. K. Khandheria, T. S. Tsang, and J. B. Seward
Increased Left Atrial Volume Index: Potent Biomarker for First-Ever Ischemic Stroke
Mayo Clin. Proc.,
October 1, 2008;
83(10):
1107 - 1114.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Garza, P. A. Pellikka, V. K. Somers, M. G. Sarr, J. B. Seward, M. L. Collazo-Clavell, E. Oehler, and F. Lopez-Jimenez
Major weight loss prevents long-term left atrial enlargement in patients with morbid and extreme obesity
Eur J Echocardiogr,
September 1, 2008;
9(5):
587 - 593.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Antonini-Canterin, C C Beladan, B A Popescu, C Ginghina, A C Popescu, R Piazza, E Leiballi, B Zingone, and G L Nicolosi
Left atrial remodelling early after mitral valve repair for degenerative mitral regurgitation
Heart,
June 1, 2008;
94(6):
759 - 764.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Farzaneh-Far and N. B. Schiller
Left atrial dimension in stress echocardiography.
J. Am. Coll. Cardiol.,
January 29, 2008;
51(4):
514 - 515.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. F Tops, E. E van der Wall, M. J Schalij, and J. J Bax
Multi-modality imaging to assess left atrial size, anatomy and function
Heart,
November 1, 2007;
93(11):
1461 - 1470.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. J. Paulus, C. Tschope, J. E. Sanderson, C. Rusconi, F. A. Flachskampf, F. E. Rademakers, P. Marino, O. A. Smiseth, G. De Keulenaer, A. F. Leite-Moreira, et al.
How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology
Eur. Heart J.,
October 2, 2007;
28(20):
2539 - 2550.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Bangalore, S.-S. Yao, and F. A. Chaudhry
Role of Left Atrial Size in Risk Stratification and Prognosis of Patients Undergoing Stress Echocardiography
J. Am. Coll. Cardiol.,
September 25, 2007;
50(13):
1254 - 1262.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Bayes-Genis, R. Vazquez, T. Puig, C. Fernandez-Palomeque, J. Fabregat, A. Bardaji, D. Pascual-Figal, J. Ordonez-Llanos, M. Valdes, A. Gabarrus, et al.
Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure
Eur J Heart Fail,
August 1, 2007;
9(8):
802 - 807.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Tumminello, P. Lancellotti, M. Lempereur, V. D'Orio, and L. A. Pierard
Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure
Eur. Heart J.,
March 1, 2007;
28(5):
569 - 574.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. F. Mitchell, R. S. Vasan, M. J. Keyes, H. Parise, T. J. Wang, M. G. Larson, R. B. D'Agostino Sr, W. B. Kannel, D. Levy, and E. J. Benjamin
Pulse Pressure and Risk of New-Onset Atrial Fibrillation
JAMA,
February 21, 2007;
297(7):
709 - 715.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Gerdts, K. Wachtell, P. Omvik, J. E. Otterstad, L. Oikarinen, K. Boman, B. Dahlof, and R. B. Devereux
Left Atrial Size and Risk of Major Cardiovascular Events During Antihypertensive Treatment: Losartan Intervention for Endpoint Reduction in Hypertension Trial
Hypertension,
February 1, 2007;
49(2):
311 - 316.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, J. Narula, D. J. Sahn, et al.
Highlights of the Year in JACC 2006
J. Am. Coll. Cardiol.,
January 30, 2007;
49(4):
509 - 527.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. J. Manning and E. V. Gelfand
Left Atrial Size and Postoperative Atrial Fibrillation: The Volume of Evidence Suggests it Is Time to Break an Old Habit
J. Am. Coll. Cardiol.,
August 15, 2006;
48(4):
787 - 789.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. P. Abhayaratna, J. B. Seward, C. P. Appleton, P. S. Douglas, J. K. Oh, A. J. Tajik, and T. S.M. Tsang
Left Atrial Size: Physiologic Determinants and Clinical Applications
J. Am. Coll. Cardiol.,
June 20, 2006;
47(12):
2357 - 2363.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
