title: Echocardiographic measurement of left atrial volume: Does the method matter?
abstract: BACKGROUND
  Four two-dimensional echocardiographic methods (cube, ellipsoid, Simpson's and area-length) can be used to assess left atrial volume (LAV).
  
  
  OBJECTIVE
  To compare absolute LAV measurements and evaluate agreement regarding the semiquantitative assessment of degree of left atrial (LA) enlargement, between methods.
  
  
  METHODS
  We prospectively measured LAV in 51 healthy volunteers using the four methods, and defined thresholds for moderate (mean+2 standard deviations [SDs]) and severe (mean+4 SDs) LA enlargement for each method. In 372 patients referred for echocardiography, we compared absolute LAV measurements and agreement between methods.
  
  
  RESULTS
  LAV was significantly different between methods in the healthy volunteer group (11 ± 4, 17 ± 3, 26 ± 6 and 28 ± 7 mL/m(2), respectively; P<0.0001), resulting in different thresholds for moderate and severe LA enlargement. LAV was also significantly different in the 372 patients (30 ± 20, 47 ± 27, 61 ± 34 and 65 ± 36 mL/m(2), respectively; P<0.0001). Agreement regarding degree of LA enlargement (none, moderate, severe), using the area-length method as reference, was modest with the cube method (kappa=0.41), correct with the ellipsoid method (kappa=0.60) and excellent with Simpson's method (kappa=0.83).
  
  
  CONCLUSIONS
  The choice of the method had a major effect on assessment of degree of LA enlargement. Our results suggest that the cube and ellipsoid methods, which significantly underestimated LAV and provided modest agreement, should be disregarded. In contrast, Simpson's method and the area-length method were slightly different, but showed close agreement, and should be preferred, using dedicated thresholds (50 and 56 mL/m(2) respectively).
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; University Paris 7, Bichat Hospital, Paris, France. Electronic address: claire.cimadevilla@bch.aphp.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Cimadevilla
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: Berjeb
authors.initials: B
authors.lastname: Nadia
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; University Paris 7, Bichat Hospital, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Dreyfus
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Perez
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Cueff
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: Michaela
authors.initials: M
authors.lastname: Malanca
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U698, Bichat Hospital, Paris, France; University Paris 7, Bichat Hospital, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U698, Bichat Hospital, Paris, France; University Paris 7, Bichat Hospital, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U698, Bichat Hospital, Paris, France; University Paris 7, Bichat Hospital, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016280:Atrial Function, Right / Q000502:physiology*; D002306:Cardiac Volume / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D064368:Healthy Volunteers; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D055815:Young Adult
keywords: Echocardiography; Left atrial volume; Oreillette gauche; Thresholds; Valeurs seuil; Volume; Échocardiographie