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Left atrial remodelling in mitral regurgitation--methodologic approach, physiological determinants, and outcome implications: a prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study.
Eur Heart J. 2007 Jul; 28(14):1773-81.EH

Abstract

AIMS

To define accurate and normal range of echocardiographic left atrial (LA) volume measurement and to assess the prevalence, determinants, and outcome implications of LA enlargement in mitral regurgitation (MR).

METHODS AND RESULTS

We prospectively compared LA volume obtained simultaneously by electron beam-computed tomography (EBCT) and by four echocardiographic methods in 33 test patients. Accurate echocardiographic LA volume measurements were obtained only by biplane area-length method with vertical longitudinal-length (r = 0.95, P < 0.0001; 145 +/- 57 vs. 143 +/- 55 mL, P = 0.57). Using this method, the normal range in 100 normal subjects, the physiological determinants and outcome implications of LA enlargement in 320 patients with organic MR were analysed. In normal subjects, indexed to body surface area, LA index (27 +/- 6 mL/m(2)) was not influenced by age or gender and values > or = 40 mL/m(2) were beyond the upper limit of normal. In MR, the most powerful determinants of LA enlargement were higher regurgitant volume (RVol) and atrial fibrillation (AF) (P < 0.0001), followed by older age, female gender, higher left ventricular end-systolic volume, and mass (all P < 0.001). After diagnosis in sinus rhythm, LA index > or = 40 mL/m(2) predicted superiorly and independently to LA diameter the occurrence of AF [adjusted RR 1.48 (1.06-2.16), P < 0.01] and the combined endpoint of death or need for mitral surgery [adjusted RR 1.61 (1.3-2.0), P < 0.0001].

CONCLUSION

LA remodelling can be accurately assessed by echocardiography and LA index > or = 40 mL/m(2) is beyond the normal range. In organic MR, higher LA index is the combined result of multiple physiological effects, provides independent prognostic information, and therefore should be part of a comprehensive echocardiographic examination.

Authors+Show Affiliations

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17562673

Citation

Messika-Zeitoun, David, et al. "Left Atrial Remodelling in Mitral Regurgitation--methodologic Approach, Physiological Determinants, and Outcome Implications: a Prospective Quantitative Doppler-echocardiographic and Electron Beam-computed Tomographic Study." European Heart Journal, vol. 28, no. 14, 2007, pp. 1773-81.
Messika-Zeitoun D, Bellamy M, Avierinos JF, et al. Left atrial remodelling in mitral regurgitation--methodologic approach, physiological determinants, and outcome implications: a prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study. Eur Heart J. 2007;28(14):1773-81.
Messika-Zeitoun, D., Bellamy, M., Avierinos, J. F., Breen, J., Eusemann, C., Rossi, A., Behrenbeck, T., Scott, C., Tajik, J. A., & Enriquez-Sarano, M. (2007). Left atrial remodelling in mitral regurgitation--methodologic approach, physiological determinants, and outcome implications: a prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study. European Heart Journal, 28(14), 1773-81.
Messika-Zeitoun D, et al. Left Atrial Remodelling in Mitral Regurgitation--methodologic Approach, Physiological Determinants, and Outcome Implications: a Prospective Quantitative Doppler-echocardiographic and Electron Beam-computed Tomographic Study. Eur Heart J. 2007;28(14):1773-81. PubMed PMID: 17562673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left atrial remodelling in mitral regurgitation--methodologic approach, physiological determinants, and outcome implications: a prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study. AU - Messika-Zeitoun,David, AU - Bellamy,Michael, AU - Avierinos,Jean-Francois, AU - Breen,Jerome, AU - Eusemann,Christian, AU - Rossi,Andrea, AU - Behrenbeck,Thomas, AU - Scott,Christopher, AU - Tajik,Jamil A, AU - Enriquez-Sarano,Maurice, Y1 - 2007/06/11/ PY - 2007/6/15/pubmed PY - 2008/2/28/medline PY - 2007/6/15/entrez SP - 1773 EP - 81 JF - European heart journal JO - Eur. Heart J. VL - 28 IS - 14 N2 - AIMS: To define accurate and normal range of echocardiographic left atrial (LA) volume measurement and to assess the prevalence, determinants, and outcome implications of LA enlargement in mitral regurgitation (MR). METHODS AND RESULTS: We prospectively compared LA volume obtained simultaneously by electron beam-computed tomography (EBCT) and by four echocardiographic methods in 33 test patients. Accurate echocardiographic LA volume measurements were obtained only by biplane area-length method with vertical longitudinal-length (r = 0.95, P < 0.0001; 145 +/- 57 vs. 143 +/- 55 mL, P = 0.57). Using this method, the normal range in 100 normal subjects, the physiological determinants and outcome implications of LA enlargement in 320 patients with organic MR were analysed. In normal subjects, indexed to body surface area, LA index (27 +/- 6 mL/m(2)) was not influenced by age or gender and values > or = 40 mL/m(2) were beyond the upper limit of normal. In MR, the most powerful determinants of LA enlargement were higher regurgitant volume (RVol) and atrial fibrillation (AF) (P < 0.0001), followed by older age, female gender, higher left ventricular end-systolic volume, and mass (all P < 0.001). After diagnosis in sinus rhythm, LA index > or = 40 mL/m(2) predicted superiorly and independently to LA diameter the occurrence of AF [adjusted RR 1.48 (1.06-2.16), P < 0.01] and the combined endpoint of death or need for mitral surgery [adjusted RR 1.61 (1.3-2.0), P < 0.0001]. CONCLUSION: LA remodelling can be accurately assessed by echocardiography and LA index > or = 40 mL/m(2) is beyond the normal range. In organic MR, higher LA index is the combined result of multiple physiological effects, provides independent prognostic information, and therefore should be part of a comprehensive echocardiographic examination. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/17562673/Left_atrial_remodelling_in_mitral_regurgitation__methodologic_approach_physiological_determinants_and_outcome_implications:_a_prospective_quantitative_Doppler_echocardiographic_and_electron_beam_computed_tomographic_study_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehm199 DB - PRIME DP - Unbound Medicine ER -