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CLINICAL RESEARCH: ECHOCARDIOGRAPHY

Predictive Value of Normal Left Atrial Volume in Stress Echocardiography

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota

Manuscript received May 23, 2005; revised manuscript received August 16, 2005, accepted September 19, 2005.

^_* Reprint requests and correspondence: Dr. James B. Seward, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.

OBJECTIVES: Our objective was to evaluate whether normal left atrial volume index (LAVI) is a predictor of a normal stress echocardiogram and thus a predictor of low ischemic risk.

BACKGROUND: Left atrial enlargement is closely related to the chronicity and intensity of the burden of increased ventricular filling pressure. Typically ischemic heart disease (IHD) has a long period of subclinical dysfunction. Increased filling pressure, reflected by enlarged LAVI, is hypothesized to mirror the burden of subclinical and overt IHD. We hypothesized that a normal LAVI might also be useful in predicting low IHD risk.

METHODS: One hundred eighty randomly selected patients (mean age, 63 ± 15 years; 53% men) underwent outpatient exercise or dobutamine stress echocardiography for known or suspected coronary artery disease. Left atrial volume index was measured retrospectively with the biplane area-length method. The stress echocardiogram was interpreted as abnormal if wall motion abnormalities (WMAs) were noted at rest and/or with stress.

RESULTS: Left atrial volume index was categorized as 28 ml/m² (normal), 28.1 to 32 ml/m², 32.1 to 36 ml/m², and >36 ml/m². Abnormal stress echocardiography was identified in 57 patients (31.7%). The percentage of abnormal stress echocardiograms in each LAVI category was 5.7%, 21.9%, 38.7%, and 54.7%, respectively. The negative predictive value for LAVI 28 ml/m² was 94.3%.

CONCLUSIONS: Normal resting LAVI (28 ml/m²) was strongly predictive of a normal stress echocardiogram. Left atrial volume index might be a simple means of identifying patients with low ischemic risk and should be further evaluated as a complement to the assessment of ischemic risk.

Abbreviations and Acronyms   CAD = coronary artery disease   IHD = ischemic heart disease   LAV = left atrial volume   LAVI = left atrial volume index   LV = left ventricle/ventricular   WMA = wall motion abnormality

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