Original Articles
Left atrial volume determination by three-dimensional echocardiography reconstruction: Validation and application of a simplified technique

https://doi.org/10.1067/mje.2002.122080Get rights and content

Abstract

Left atrial (LA) size assessment by anteroposterior dimension is limited in accuracy. Conventional 3-dimensional (3D) reconstruction has been validated, but the process is time-consuming and the 3D system is not widely available. We developed an algorithm to simplify 3D reconstruction of LA on the basis of 3 standard apical views, tested it in 44 hemodynamic stages of 8 open-chest dogs, and compared it with LA volumes assessed by conventional 3D reconstruction. Simplified 3D reconstruction provided an accurate LA volume measurement (y = 0.93x + 0.7, r = 0.95, standard error of the estimate [SEE] = 3.6) with more than 60% of time saved. Cubic equation of anteroposterior dimension and biplane modified Simpson's method were less accurate (for biplane modified Simpson's method, y = 0.8x + 2.6, r = 0.88, SEE = 5.0; for cubic equation of anteroposterior dimension, y = 0.65x + 2.6, r = 0.76, SEE = 8.2). Without the need for a 3D-imaging acquisition tool, simplified 3D reconstruction can be applied in the clinical setting for LA size quantitation with significant time saved. (J Am Soc Echocardiogr 2002;15:1051-6.)

Section snippets

Animal preparation

Eight mongrel dogs, weighing between 21 and 35 kg, were anesthetized with phenobarbital (30 mg/kg intravenously), intubated, and mechanically ventilated. A midline thoracotomy was performed and the heart was suspended in a pericardial cradle. Each animal was studied in a series of hemodynamic stages created by volume loading into the LA. The amount of fluid added at each stage was randomly selected (ranging from 1-3 mL). Four to 5 hemodynamic stages were created for each dog. The resulting LA

Results

Three-dimensional reconstruction was successfully performed in all 44 hemodynamic stages by both C3DR and S3DR. LA APD range was 1.8 to 3.6 cm (mean = 2.7 ± 0.5 cm). Table 1 presents a statistical description of the results.

. Statistical description of results.

EchocardiographynMean (mL)Median (mL)SDRange (mL)
Cub4821.217.611.25.8-46.7
Bip4825.727.210.85.6-42.3
S3DR4827.329.311.65.5-46.0
C3DR4828.730.111.97.1-49.3

Cub, Cubic equation of anteroposterior dimension; Bip, biplane modified Simpson's

Discussion

LA size has been acknowledged as an important risk factor in identifying a subset of persons at increased risk for developing atrial fibrillation.20 The Framingham Heart Study21 revealed that after adjustment for age, hypertension, diabetes, smoking, left ventricular hypertrophy by electrocardiography, prevalent atrial fibrillation, and prevalent congestive heart failure or myocardial infarction, LA size remained a significant predictor of stroke in men, and death in both genders. LA size is

Conclusion

Despite its irregular shape, the LA can be reconstructed by 3D echocardiography and its volume can be accurately quantified in vivo without the need for geometric assumption or individual standardized views. S3DR and C3DR provide better estimations of LA volume than those derived from the 2D method with less observer variability. S3DR is designed to overcome the limitation in conventional 3D imaging with significant time saved and low interobserver variability. It could plausibly be performed

References (26)

Cited by (0)

Reprint requests: Banthit Khankirawatana, MD, University of Nebraska Medical Center, 981165 Nebraska Medical Center, Omaha, NE 68198-1165 (E-mail: [email protected]).

View full text