Left atrial volume indexed for height2 is a new sensitive marker for subclinical cardiac organ damage in female hypertensive patients

Airale, Lorenzo; Paini, Anna; Ianniello, Eugenia; Mancusi, Costantino; Moreo, Antonella; Vaudo, Gaetano; Avenatti, Eleonora; Salvetti, Massimo; Bacchelli, Stefano; Izzo, Raffaele; Scocco, Paola; Arrivi, Alessio; Muiesan, María Lorenza; Esposti, Daniela Degli; Giannattasio, Cristina; Pucci, Giacomo; Luca, Nicola De; Milan, Alberto

doi:10.1038/s41440-021-00614-4

Cited by 10 publications

(11 citation statements)

References 25 publications

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“…Similar results were obtained using long-term cardiovascular mortality not limited to five years, and both long-term and five-year all-cause mortality (Supplementary tables 2-4). Similar trends were observed across indexation of other aortic dimensions (sinotubular junction, ascending, root, arch) and cardiac chamber volumes (left atrial end-systolic diameter and volume, left ventricular end-diastolic volume) (Supplementary figures 1-15, Supplementary tables [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Across all measures, the 95% confidence interval of the Cstatistic remains significant for the normal and overweight group.…”

Section: Resultssupporting

confidence: 52%

“…However, indexation never negatively impacts prognostic performance. Kaplan Meier curves did not show visually appreciable differences between indexation by BSA compared to indexation by weight across any measure (Supplementary figures [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Relative prognostic strength of different cardiac and aortic size measures.…”

Section: Resultsmentioning

confidence: 99%

“…16 Studies on indexation for prognostic performance have been limited in patient sample size and range of cardiac measures indexed. 5,[17][18][19][20] Using the large-scale data available in the National Echocardiography Database of Australia (NEDA), the aim of the study was to derive one or more formulae based on height and weight to provide a method of body size indexation of cardiac and aortic measures that will be a better predictor of all-cause mortality than current methods based on body surface area.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic association supports indexing size measures in echocardiography by body surface area

Fung

Soundappan

Loewenstein

et al. 2021

Preprint

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BACKGROUNDBody size indexation is a foundation of the diagnostic interpretation of cardiac size measures used in imaging assessment of cardiovascular health. Body surface area (BSA) is the most commonly used metric for body size indexation of echocardiographic measures, but its use in patients who are underweight or obese is questioned (body mass index (BMI) <18·5 kg/m2 or ≥30 kg/m2, respectively). We hypothesized that mortality can be used to identify an optimal body size indexation metric for echocardiographic measures that would be a better predictor of survival than BSA regardless of BMI.METHODSIn this big data, cohort study, adult patients with no prior valve replacement were selected from the National Echo Database Australia. Survival analysis was performed for echocardiographic measures both unindexed and indexed to different body size metrics, with 5-year cardiovascular mortality as the primary endpoint.FINDINGSIndexation of echocardiographic measures (left ventricular diameter [n=337,481] and mass [n=330,959], left atrial area [n=136,989], aortic sinus diameter [n=125,130], right atrial area [n=81,699], right ventricular diameter [n=3,575], right ventricular outflow tract diameter [n=2,841]) by BSA had better prognostic performance vs unindexed measures (healthy/overweight: C-statistic 0·656 vs 0·618, average change in Akaike Information Criteria (ΔAIC) 800; underweight: C-statistic 0·669 vs 0·654, ΔAIC 15; obese: C-statistic 0·630 vs 0·612, ΔAIC 113). Indexation by other body size metrics (lean body mass or height and/or weight raised to various powers) did not improve prognostic performance versus BSA by a clinically relevant magnitude (average C-statistic increase ≤0·01), with smaller differences in higher BMI subgroups. Similar results were obtained using sex-disaggregated analysis, for indexation of other aortic or cardiac dimension or volume measures, and for all-cause mortality.INTERPRETATIONIndexing measures of cardiac and aortic size by BSA improves prognostic performance regardless of BMI, and no other body size metric has a clinically meaningful better performance.FUNDINGThis research was supported in part by grants (PI Ugander) from New South Wales Health, Heart Research Australia, and the University of Sydney.

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Section: Resultssupporting

confidence: 52%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic association supports indexing size measures in echocardiography by body surface area

Fung

Soundappan

Loewenstein

et al. 2021

Preprint

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“…The use of alternative methods of indexing LA size in obese individuals has been a subject of several published studies [5,[10][11][12][13][14][15][16] that have shown that when LA size was indexed based on methods that were not weight dependent, a higher prevalence of LAE was noted. Yao et al [15] examined 266 overweight and obese individuals (divided into 3 classes) along with 46 controls with normal BMI for different indexing methods of LA dimension (LAD) and showed that LAD was overcorrected by body weight, BMI, and/ or BSA, but indexing LAD to height showed a significant and graded increase across the groups of increased BMI; thus, authors concluded that it should be the preferred method in indexing LAD among the obese.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Left Atrial Enlargement According to Different Modes of Indexing in Overweight and Obese Individuals

Ilijevska

Andova

Georgievska-Ismail

2023

Prilozi

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Background: Current guidelines recommend indexing left atrial volume (LAV) by body surface area (BSA). However, in overweight and obese individuals this may result in the underestimation of left atrial enlargement (LAE). The aim of our study was to assess whether alternative LAV indexing to height and/or height-squared better identifies individuals with LAE among those who are overweight and/or obese. Methods: LAV was indexed to BSA (LAVI), height (LAVh), and height-squared (LAVh2) in 127 individuals with a mean age of 45.7 years and a mean body mass index (BMI) of 34.9 kg/m2 who underwent outpatient echocardiography at the University clinic of cardiology in Skopje. Results: LAVI, LAVh, and LAVh2 showed a progressive increase of respective values with the extent of BMI showing the most enlarged LA size in individuals with Class III obesity. There was a progressive significant increase in the prevalence of LAEh and LAEh2 in obese groups with the highest prevalence among those with class III obesity (p=0.002, p=0.002, respectively), on the contrary of LAEBSA where we could not find any significance in its distribution among obese classes. The greatest degree of reclassification occurred when indexing for height-squared, having relatively less reclassification when indexing for height (p=0.0001). The degree of reclassification varied depending on BMI with the greatest impact among the Class III obese patients, where as many as 76.5% and 88.2% of individuals were reclassified according to height or height-squared, respectively. Conclusions: The use of height, and especially height-squared, in comparison to BSA-based indexing methods are more successful in identifying the LAE prevalence in each class of obesity. Using allometric indexation leads to the significant reclassification of LA size from normal to dilated, especially in women and those with severe obesity, thereby providing an opportunity to identify more individuals at increased risk of adverse events.

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“…In the SPRINT study, intensive BP management was not associated with LA abnormalities defined based on ECG [ 47 ]. Although LA volume (LAV) according to body surface area was recommended to assess LA size [ 48 ], LAV indexed for height 2 was shown to be more sensitive for detecting subclinical hypertensive organ damage in females [ 49 ]. In the ARIC study, the minimum but not the maximum LAV index was significantly associated with the risk of incident HFpEF or death [ 50 ].…”

Section: Hypertension and Heart Disease-focusing On The Relationship ...mentioning

confidence: 99%

Update on Hypertension Research in 2021

et al. 2022

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Left atrial volume indexed for height2 is a new sensitive marker for subclinical cardiac organ damage in female hypertensive patients

Cited by 10 publications

References 25 publications

Prognostic association supports indexing size measures in echocardiography by body surface area

Prognostic association supports indexing size measures in echocardiography by body surface area

Frequency of Left Atrial Enlargement According to Different Modes of Indexing in Overweight and Obese Individuals

Update on Hypertension Research in 2021

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