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J Am Coll Cardiol, 2003; 41:1422-1423, doi:10.1016/S0735-1097(03)00153-0
© 2003 by the American College of Cardiology Foundation
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LETTER TO THE EDITOR

Calculating the absolute value of the mean left atrial maximal and minimal volume

Andrea Rossi, MD

Dipartimento di Scienze Biomediche e Chirurgiche, Sezione di Cardiologia, Universitá di Verona, Ospedale Maggiore, P.le Stefani 1, 37126 Verona, Italy

andrea.rossi{at}univr.it

We enjoyed the study by Thomas et al. published in the Journal (1); however, we have some concern regarding the absolute value of the calculated mean left atrial maximal and minimal volume. In patients without mitral regurgitation, the reservoir volume (left atrial total emptying volume) of the left atrium represents the amount of blood coming from the pulmonary vein during ventricular systole. In the case of the younger group of the present study, 22.5 ml of blood fills the left atrium from the pulmonary vein during systole. Because the systolic fraction of the pulmonary vein is 56% (of the systo-diastolic flow), we can assume that the total flow coming from the pulmonary vein (which reflects the total forward stroke volume) is 40 ml. Consequently, for the reported heart rate and body surface area, the cardiac index is 1.5 l/min/m2, which is surprisingly low for a normal patient population. This rough calculation is enforced by the observation during transesophageal echocardiography that the diameter of the pulmonary vein does not change so much during the entire cardiac cycle. It has been shown that left atrial volume measured by echocardiography is underestimated compared with both cine-computed tomography (2) and magnetic resonance imaging (3). Would it not be useful to consider a physiologic variable such as cardiac output to evaluate the accuracy of volume measurement?


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  1. Thomas L, Levett K, Boyd A, Leung DYC, Schiller NB, Ross DL. Compensatory changes in atrial volumes with normal aging: is atrial enlargement inevitable? J Am Coll Cardiol. 2002;40:1630–1635[Abstract/Free Full Text]
  2. Kirker B, Abbott JA, Pau S, et al. Left atrial volume determination by biplane two-dimensional echocardiography: validation by cine computed tomography. Am Heart J. 1991;121:864–871[CrossRef][Medline]
  3. Rodevan O, Bjornerheim R, Ljosland M, Maehle J, Smith HJ, Ihlen H. Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Card Imaging. 1999;15:397–410[CrossRef][Medline]

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Liza Thomas, Dominic Y. C. Leung, Nelson B. Schiller, and David L. Ross
J. Am. Coll. Cardiol. 2003 41: 1424. [Full Text] [PDF]




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