Comparison between real-time 3-dimensional and 2-dimensional biplane echocardiographic assessment of left atrial volumes in dogs with myxomatous mitral valve disease

Background: Assessment of left atrial (LA) size is important in medical decision making and prognostication in dogs with myxomatous mitral valve disease (MMVD). Real-time 3-dimensional (RT3DE) and 2-dimensional echocardiographic (2DE) methods may be used to assess LA size.

Objectives: To compare measured LA volumes obtained by RT3DE with those calculated by biplane Simpson's modified method of discs (SMOD) and the area-length method (ALM) using the same RT3DE acquisition with the same timing.

Animals: One hundred twenty-one privately owned dogs with naturally occurring MMVD.

Methods: Prospective observational study comparing LA volumes indexed to body weight using RT3DE and 2DE-based biplane SMOD and ALM. Agreement between methods was evaluated using Bland-Altman plots and linear regression analyses.

Results: Estimations of LA volume using SMOD or ALM did not show good agreement with RT3DE-derived measurements. Absolute differences between methods increased with increasing LA volume, but SMOD underestimated whereas ALM overestimated calculated volumes compared to RT3DE-derived measurements. The difference in LA volume between RT3DE and the biplane methods showed a systematic underestimation of 7% for SMOD and a systematic overestimation of 24% for ALM. Comparison of LA volumes obtained by SMOD and ALM did not show good agreement. The ALM yielded 30% larger LA volumes compared to SMOD.

Conclusion and clinical importance: In comparison with RT3DE, SMOD systematically underestimated whereas ALM systematically overestimated LA volumes in dogs with MMVD. Because the systematic difference between RT3DE and SMOD was only 7%, SMOD might be considered the method of choice.