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JACC Cardiovasc Imaging. 2013 Oct;6(10):1025-35. doi: 10.1016/j.jcmg.2013.08.002. Epub 2013 Sep 4.

Prognostic value of LA volumes assessed by transthoracic 3D echocardiography: comparison with 2D echocardiography.

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  • 1Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.

Abstract

OBJECTIVES:

The hypothesis of this study was that minimal left atrial volume index (LAVImin) by 3-dimensional echocardiography (3DE) is the best predictor of future cardiovascular events.

BACKGROUND:

Although maximal left atrial volume index (LAVImax) by 2-dimensional echocardiography (2DE) is a robust index for predicting prognosis, the prognostic value of LAVImin and the superiority of measurements by 3DE over 2DE have not been determined in a large group of patients.

METHODS:

In protocol 1, we assessed age and sex dependency of LAVIs using 2DE and 3DE in 124 normal subjects and determined their cutoff values (mean + 2 SD). In protocol 2, 2-dimensional (2D) and 3-dimensional (3D) LAVImax/LAVImin were measured in 556 patients with high prevalence of cardiovascular disease. After excluding patients with atrial fibrillation, mitral valve disease, and age <18 years, 439 subjects were followed to record major adverse cardiovascular events (MACE). Patients were divided into 2 groups by the cutoff criteria of LAVI in each method.

RESULTS:

In protocol 1, there was no significant age and sex dependency for each 2D and 3D LAVI. In protocol 2, during a mean of 2.5 years of follow-up, MACE developed in 88 patients, including 32 cardiac deaths. Kaplan-Meier survival analyses showed that all 4 LAVI cutoff criteria had significant predictive power of MACE. After variables were adjusted for clinical variables and left ventricular ejection fraction, all 4 methods were still independently and significantly associated with MACE, but 3D-derived LAVImin had the highest risk ratio. 3D LAVImin also had an incremental prognostic value over 3D LAVImax.

CONCLUSIONS:

LAVIs by both 2DE and 3DE are powerful predictors of future cardiac events. 3D LAVImin tended to have a stronger and additive prognostic value than 3D LAVImax.

Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

2-dimensional; 2-dimensional echocardiography; 2D; 2DE; 3-dimensional; 3-dimensional echocardiography; 3D; 3D echocardiography; 3DE; CKD; HF; ICC; LA; LAV; LAVI; LAVImax; LAVImin; LAVmax; LAVmin; LV; LVEF; MACE; chronic kidney disease; heart failure; intraclass correlation coefficient; left atrial; left atrial volume; left atrial volume index; left atrium; left ventricular; left ventricular ejection fraction; major adverse cardiac events; maximal left atrial volume; maximal left atrial volume index; minimal left atrial volume; minimal left atrial volume index; prognosis

PMID:
24011776
[PubMed - indexed for MEDLINE]
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