Assessment of left atrial volume and function: a comparative study between echocardiography, magnetic resonance imaging and multi slice computed tomography

Abstract

Measurement of left atrial (LA) maximal volume (LA(max)) using two-dimensional transthoracic echocardiography (TTE) provides prognostic information in several cardiac diseases. However, the relationship between LA(max) and LA function is poorly understood and TTE is less well suited for measuring dynamic LA volume changes. Conversely, cardiac magnetic resonance imaging (CMR) and multi-slice computed tomography (MSCT) appears more appropriate for such measures. We sought to determine the relationship between LA size assessed with TTE and LA size and function assessed with CMR and MSCT. Fifty-four patients were examined 3 months post myocardial infarction with echocardiography, CMR and MSCT. Left atrial volumes and LA reservoir function were assessed by TTE. LA time-volume curves were determined and LA reservoir function (cyclic change and fractional change), passive emptying function (reservoir volume) and pump function (left atrial ejection fraction-LAEF) were derived using CMR and MSCT. Left atrial fractional change and left atrial ejection fraction (LAEF) determined with CMR and MSCT were unrelated to LA(max) enlargement by echocardiography (P = NS). There was an overall good agreement between CMR and MSCT, with a small to moderate bias in LA(max) (4.9 ± 10.4 ml), CC (3.1 ± 9.1 ml) and reservoir volume (3.4 ± 9.1 ml). TTE underestimates LA(max) with up to 32% compared with CMR and MSCT (P < 0.001). Left atrial function assessed with MSCT and CMR as LA fractional change and LAEF is not significantly related to LA(max) measured by TTE. TTE systematically underestimated LA volumes, whereas there are good agreements between MSCT and CMR for volumetric and functional properties.

Left Atrial Volumes and Function by Three-Dimensional Echocardiography

“…This is in contrast with all the other studies that have compared 2DE versus 3DE LA volumes and reported a 20% underestimation of LA volumes by 2DE in comparison to computed tomography and CMR. 3,4 We think that there may be several reasons for the differences between our study and earlier reports. In both previous studies, a software package designed for LV volume analysis was adapted to measure the LA volume by 3DE, whereas we have used a software specifically designed for LA analysis.…”

Left Atrial Passive Emptying Function Is Preserved in Patients with Permanent Atrial Fibrillation - A 320-Slice Multidetector Computed Tomography Study

“…We have recently demonstrated that measurements of LA max and LA min in patients with permanent AF obtained by MDCT correlate closely with measurements obtained by CMR and that the reproducibility of both MDCT and CMR is superior to echocardiography [18]. Also, the reproducibility of MDCT in patients with AF is comparable to results previously reported for patients in SR [11,21], which suggests that application of 320-slice MDCT is indeed feasible in patients with AF.…”

“…Previously, a good interobserver agreement has been reported for measurements of LA volumes assessed by MDCT in SR patients [21]. …”

“…The CV is not reflected on the time-volume curve, since the curve only reflects atrial emptying caused by passive and active contraction, but CV can be calculated as LVSV - (RV + LASV). We have previously reported an excellent agreement between MDCT and CMR for measurements of LA volumes in SR patients [21]. …”

Left Atrial Wall Thickness and Pulmonary Vein Size are Increased in Patients with Atrial Fibrillation Compared to Healthy Controls - A Multidetector Computed Tomography Study

“…However, recent developments in MDCT have made it possible to visualize the LA in greater details, including wall characteristics and the PV size noninvasively with high spatial and reasonable temporal resolution by creating high-quality three-dimensional images [6]. This widely accessible imaging modality may be used to provide a more detailed anatomical evaluation and road map before ablation, in terms of both LA and PV anatomy [3,[7][8][9][10][11][12]. Recent studies indicate that LA and PV characteristics as determined by cardiac MDCT are possible important predictors of AF recurrence after ablation therapy [11,[13][14][15][16], and that the thicker the parts of the LA are, the less successful ablation therapy becomes [13,17].…”