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 Echocardiography Research Center
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.
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