Reference left atrial dimensions and volumes by steady state free precession cardiovascular magnetic resonance

Abstract

BackgroundLeft atrial (LA) size is related to cardiovascular morbidity and mortality. Cardiovascular magnetic resonance (CMR) provides high quality images of the left atrium with high temporal resolution steady state free precession (SSFP) cine sequences. We used SSFP cines to define normal ranges for LA volumes and dimensions relative to gender, age and body surface area (BSA), and examine the relative value of 2D atrial imaging techniques in patients.For definition of normal ranges of LA volume we studied 120 healthy subjects after careful exclusion of cardiovascular abnormality (60 men, 60 women; 20 subjects per age decile from 20 to 80 years). Data were generated from 3-dimensional modeling, including tracking of the atrioventricular ring motion and time-volume curves analysis. For definition of the best 2D images-derived predictors of LA enlargement, we studied 120 patients (60 men, 60 women; age range 20 to 80 years) with a clinical indication for CMR.ResultsIn the healthy subjects, age was associated with LA 4-chamber transverse and 3-chamber anteroposterior diameters, but not with LA volume. Gender was an independent predictor of most absolute LA dimensions and volume, but following normalization to BSA, some associations became non-significant. CMR normal ranges were modeled and are tabled for clinical use with normalization, where appropriate, for BSA and gender and display of parameter variation with age. The best 2D predictors of LA volume were the 2-chamber area and 3-chamber area (both r = 0.90, p < 0.001).ConclusionsThese CMR data show that LA dimensions and volume in healthy, individuals vary significantly by BSA, with lesser effects of age and gender.

Cardiovascular magnetic resonance imaging assessment of diastolic dysfunction in a population without heart disease: a gender-based study

“…Hudsmith et al [6,21] also reported higher absolute LA volumes in male patients with similar ejection fraction in patients of both genders. Regarding indexed LA volumes, our findings are broadly consistent with those reported by Maceira et al [4]. The effect of age may explain the greater indexed LA maximum volumes observed in men.…”

“…Several studies have defined CMR normal ranges of LV volumes and systolic function [4][5][6][7][8][9][10][11] but none has assessed the prevalence of left ventricular diastolic dysfunction in healthy adult individuals.…”

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

“…329,331,[333][334][335][336][337][338][339]345,[347][348][349][350][351][352][353][354][355][356][357][358][359][360] Two-dimensional echocardiographic LA volumes are typically smaller than those reported from computed tomography or cardiac magnetic resonance imaging (CMR). [361][362][363][364][365] Left atrium volume from 2D images is best measured using the disk summation algorithm because it includes fewer geometric assumptions. 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.…”

Atrial remodelling is less pronounced in female endurance-trained athletes compared with that in male athletes

“…This form of scaling may be useful in a normal population where atrial volumes vary with BSA (11). However, in an athletic population the atrial volumes are also increased due to training and therefore all volumes normalized for BSA will be higher and often above the limits of normal remodeling (6).…”

“…Cut off values for normal atrial remodeling are often presented normalized for body surface area (BSA) (8)(9)(10)(11)(12). This form of scaling may be useful in a normal population where atrial volumes vary with BSA (11).…”