title: Automated quantification of left atrial size using three-beat averaging real-time three dimensional Echocardiography in patients with atrial fibrillation.
abstract: BACKGROUND
  Left atrial (LA) sizing in patients with atrial fibrillation (AF) is crucial for follow-up and outcome. Recently, the automated quantification of LA using the novel three-beat averaging real-time three dimensional echocardiography (3BA-RT3DE) is introduced. The aim of this study was to assess the feasibility and accuracy of 3BA-RT3DE in patients with atrial fibrillation (AF).
  
  
  METHODS
  Thirty-one patients with AF (62.8 ± 11.7 years, 67.7 % male) were prospectively recruited to have two dimensional echocardiography (2DE) and 3BA-RT3DE (SC 2000, ACUSON, USA). The maximal left atrial (LA) volume was measured by the conventional prolate-ellipse (PE) and area-length (AL) method using three-beat averaging 2D transthoracic echocardiography and automated software analysis (eSie volume analysis, Siemens Medical Solution, Mountain view, USA); measurements were compared with those obtained by computed tomography (CT).
  
  
  RESULTS
  Maximal LA volume by 3BA-RT3DE was feasible for all patients. LA volume was 68.4 ± 28.2 by PE-2DE, 89.2 ± 33.1 by AL-2DE, 100.6 ± 31.8 by 3BA-RT3DE, and 131.2 ± 42.2 mL by CT. LA volume from PE-2DE (R(2) = 0.48, p < 0.001, ICC = 0.64, p < 0.001), AL-2DE (R(2) = 0.47, p < 0.001, ICC = 0.67, p < 0.001), and 3BA-RT3DE (R(2) = 0.50, p = 0.001, ICC = 0.65, p < 0.001) showed significant correlations with CT. However, 3BA-RT3DE demonstrated a small degree of underestimation (30.5 mL) of LA volume compared to 2DE-based measurements. Good-quality images from 3BA-RT3DE (n = 16) showed a significantly tighter correlation with images from CT scanning (R(2) = 0.60, p = 0.0004, ICC = 0.76, p < 0.001) compared to those of fair quality.
  
  
  CONCLUSIONS
  Automated quantification of LA volume using 3BA-RT3DE is feasible and accurate in patients with AF. An image of good quality is essential for maximizing the value of this method in clinical practice.
authors: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Ran
authors: R
authors: Heo
authors: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. grhong@yuhs.ac.
authors: Geu-Ru
authors: GR
authors: Hong
authors: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Young-Jin
authors: YJ
authors: Kim
authors: Ultrasound Division, Siemens Medical Solution, Mountain View, CA, USA.
authors: Joel
authors: J
authors: Mancina
authors: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: In-Jeong
authors: IJ
authors: Cho
authors: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Chi Young
authors: CY
authors: Shim
authors: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Hyuk-Jae
authors: HJ
authors: Chang
authors: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Jong-Won
authors: JW
authors: Ha
authors: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Namsik
authors: N
authors: Chung
mesh_terms: D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging*; D003199:Computer Systems; D003627:Data Interpretation, Statistical; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity