Journal of the American Society of Echocardiography
Original ArticlesLeft atrial volume determination by three-dimensional echocardiography reconstruction: Validation and application of a simplified technique☆
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.
Cub, Cubic equation of anteroposterior dimension; Bip, biplane modified Simpson'sEchocardiography n Mean (mL) Median (mL) SD Range (mL) Cub 48 21.2 17.6 11.2 5.8-46.7 Bip 48 25.7 27.2 10.8 5.6-42.3 S3DR 48 27.3 29.3 11.6 5.5-46.0 C3DR 48 28.7 30.1 11.9 7.1-49.3
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
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Reprint requests: Banthit Khankirawatana, MD, University of Nebraska Medical Center, 981165 Nebraska Medical Center, Omaha, NE 68198-1165 (E-mail: [email protected]).