Revisiting left atrial volumetry by magnetic resonance imaging: the role of atrial shape and 3D angle between left ventricular and left atrial axis

Abstract

Background Accurate measurement of left atrial (LA) volumes is needed in cardiac diagnostics and the follow up of heart and valvular diseases. Geometrical assumptions with 2D methods for LA volume estimation contribute to volume misestimation. In this study, we test agreement of 3D and 2D methods of LA volume detection and explore contribution of 3D LA axis orientation and LA shape in introducing error in 2D methods by cardiovascular magnetic resonance imaging. Methods 30 patients with prior first-ever ischemic stroke and no known heart disease, and 30 healthy controls were enrolled (age 18–49) in a substudy of a prospective case–control study. All study subjects underwent cardiac magnetic resonance imaging and were pooled for this methodological study. LA volumes were calculated by biplane area-length method from both conventional long axis (LAVAL-LV) and LA long axis-oriented images (LAVAL-LA) and were compared to 3D segmented LA volume (LAVSAX) to assess accuracy of volume detection. 3D orientation of LA long axis to left ventricular (LV) long axis and to four-chamber plane were determined, and LA 3D sphericity indices were calculated to assess sources of error in LA volume calculation. Shapiro–Wilk test, Bland–Altman analysis, intraclass and Pearson correlation, and Spearman’s rho were used for statistical analysis. Results Biases were − 9.9 mL (− 12.5 to − 7.2) for LAVAL-LV and 13.4 (10.0–16.9) for LAVAL-LA [mean difference to LAVSAX (95% confidence interval)]. End-diastolic LA long axis 3D deviation angle to LV long axis was 28.3 ± 6.2° [mean ± SD] and LA long axis 3D rotation angle to four-chamber plane 20.5 ± 18.0°. 3D orientation of LA axis or 3D sphericity were not correlated to error in LA volume calculation. Conclusions Calculated LA volume accuracy did not improve by using LA long axis-oriented images for volume calculation in comparison to conventional method. We present novel data on LA axis orientation and a novel metric of LA sphericity and conclude that these measures cannot be utilized to assess error in LA volume calculation. Trial registration Main study Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) has been registered previously.

A method for measuring the angle between left atrial and left ventricular long axes using 3D echocardiography

“…If the axes of the LA and LV are not codirectional, this might reasonably cause foreshortening of the LA and thus inaccurate measurements of the LA parameters. Using cardiac MRI, the concept of the angle between the LA and LV long axes (LA‐LV angle) measurement has recently been established 6 . To our knowledge only a single study has previously utilized this concept in CT imaging, concerning only volume measurements, and has found only minor differences in 2D volume calculation accuracy with respect to the LA‐LV angle 7 .…”

“…Using cardiac MRI, the concept of the angle between the LA and LV long axes (LA-LV angle) measurement has recently been established. 6 To our knowledge only a single study has previously utilized this concept in CT imaging, concerning only volume measurements, and has found only minor differences in 2D volume calculation accuracy with respect to the LA-LV angle. 7 Using echocardiography, atrial-focused views have been shown to yield better LA volume estimations than traditional LV-focused views, 8 but the determinants of this difference-such as, possibly, the LA-LV angle-have not been known previously.…”