Left atrium reclassified: application of the American Society of Echocardiography/European Society of Cardiology cutoffs to unselected outpatients referred to the echocardiography laboratory.
OBJECTIVE
We sought to determine whether categorization of abnormal left atrial (LA) size based on volumes indexed to body surface area (LAVi) results in reclassification of LA dilatation if the classic antero-posterior diameter (LAd) was measured. The American Society of Echocardiography/European Society of Cardiology recommended LAVi over linear measurements and recently published cutoffs to qualify LA dilatation. However, many laboratories continue to use the LAd because it appears easier to measure.


METHODS
Unselected adult outpatients referred to the echocardiography laboratory for any indication in the period March 2005 to January 2006 prospectively underwent standard Doppler echocardiography, including real-time measurement of LAd and LAVi.


RESULTS
We enrolled 578 patients (mean age 66 +/- 14 years, 56% women). There was a good positive linear correlation between LAd and LAVi (r = 0.686, P < .0001). When the published cutoffs for LA enlargement were used, 49.0% of patients were classified as having abnormal LA by LAd and 76.3% by LAVi (P < .001). Of the 295 who had normal LA by LAd, 58.6% patients had abnormal LAVi. Conversely, of the 283 with abnormal LAd, almost all patients (94.7%) had abnormal LAVi. The proportion of overall agreement was 67.5% (kappa = 0.357, P < .001).


CONCLUSIONS
Assessment of LA size by LAVi allows identification of patients with enlarged atria that would have been missed if classified by antero-posterior diameters, especially when cutoffs are applied.
Barbieri
Andrea
A
Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy.
Bursi
Francesca
F
Zanasi
Vera
V
Veronesi
Benedetta
B
Cioni
Elena
E
Modena
Maria Grazia
MG
D002309:Cardiology / Q000592:standards; D004452:Echocardiography / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006325:Heart Atria / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D006801:Humans; D038801:International Classification of Diseases; D007558:Italy / Q000453:epidemiology; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data*; D012015:Reference Standards; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014481:United States