Left atrial volume measurement with automated border detection by 3-dimensional echocardiography: comparison with magnetic resonance imaging

Abstract

Objective: Left atrial size is an important marker for adverse cardiovascular events. There is general consensus that left atrial volume index (LAVI) is the best measurement of size. The current LAVI measurement techniques are laborious. Semi-automated measurement with a 3-dimensional echocardiography (3DE) system may be a practical clinical alternative to measure LAVI, but it has not been adequately evaluated against Magnetic Resonance Imaging (MRI) gold standard. The aim of this study was to compare the accuracy of a commercially available 3D algorithm for measurement of LAVI against LAVI obtained from MRI and Area Length Method (ALM). Design:In 27 consecutive subjects referred for cardiac MRI (age 54 ± 13 years, 63% male), LAVI was measured using 3 imaging modalities: 3DE, ALM, MRI and the results were correlated. ALM was measured using standard American Society of Echocardiography guidelines. The time required to measure LAVI by 3DE and ALM were compared.Results: There was a significant correlation in systolic and diastolic LA volumes and left atrial ejection fraction between 3DE and MRI (r = 0.86 for systole, r = 0.76 for diastole, r = 0.88 for ejection fraction, P < 0.0001 for all). There was also significant correlation of diastolic volumes between 3DE and ALM (r = 0.77, P < 0.0001). The time to obtain LAVI was shorter using 3DE versus ALM (56 ± 8 vs 135 ± 55 seconds, P < 0.0001). Conclusion:Three-dimensional echocardiography with semiautomatic border detection is a practical alternative for obtaining the left atrial volume in a time-efficient manner compared to the current standard.

Assessment of left atrial functional parameters using a novel dedicated analysis tool for real-time three-dimensional echocardiography: validation in comparison to magnetic resonance imaging

“…Our data demonstrate very high correlations for LA max , LA min , LAEF, and LAEF true when compared to cardiac MRI. In line with previous studies comparing RT3DE assessment of the LA to MRI or CT, the present data demonstrate a consistent underestimation of RT3DE volumes [15,18].…”

“…In the present study, however, the differences were less pronounced than previously reported [15,18]. The higher spatial resolution of MRI in comparison to RT3DE has been repeatedly suggested as a likely explanation for the general underestimation of LA volumes by RT3DE along with a possible inclusion of pulmonary venous confluence or even part of the LA appendage into the actual LA volume when assessed by MRI.…”

“…Previously published studies assessing LA functional parameters using RT3DE, however, had to rely on semiautomatic contour tracing algorithms originally developed for the left ventricle [15][16][17].…”

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…366,367 The advent of 3-D ECHO has improved the accuracy of ECHO volume measurements which correlate well with cardiac computed tomography 368,369 and magnetic resonance imaging. 370,371 Compared with 2D assessment of LA volume, 3DE also has superior prognostic prediction. 372,373 The recommended upper normal indexed LA volume is 34 mL/m 2 for both genders which fits well with a risk-based approach for determination of cut-off between a normal and an enlarged LA.…”

Left Atrial Volume: Comparison of 2D and 3D Transthoracic Echocardiography with ECG-gated CT Angiography

“…Until recently, however, 3D-TTE has had limited clinical applicability because of relatively laborious and time intensive acquisition and off-line processing [13][14] . The introduction of 'real time' 3D-TTE using matrix array transducers has resulted in sufficiently rapid image acquisition for clinical applications, but has not been rigorously validated 15 .…”