title: Multivariate Analysis of Correspondence between Left Atrial Volumes Assessed by Echocardiography and 3-Dimensional Electroanatomic Mapping in Patients with Atrial Fibrillation.
abstract: BACKGROUND
  Left atrial (LA) enlargement is a predictor of worse outcome after catheter ablation for atrial fibrillation (AF). Widely used two-dimensional (2D)-echocardiography is inaccurate and underestimates real LA volume (LAV). We hypothesized that baseline clinical characteristics of patients can be used to adjust 2D-ECHO indices of LAV in order to minimize this disagreement.
  
  
  METHODS
  The study enrolled 535 patients (59 ± 9 years; 67% males; 43% paroxysmal AF) who underwent catheter ablation for AF in three specialized centers. We investigated multivariately the relationship between 2D-echocardiographic indices of LA size, specifically LA diameter in M-mode in the parasternal long-axis view (LAD), LAV assessed by the prolate-ellipsoid method (LAVEllipsoid), LAV by the planimetric method (LAVPlanimetry), and LAV derived from 3D-electroanatomic mapping (LAVCARTO).
  
  
  RESULTS
  Cubed LAD of 106 ± 45 ml, LAVEllipsoid of 72 ± 24 ml and LAVPlanimetry of 88 ± 30 ml correlated only modestly (r = 0.60, 0.69, and 0.53, respectively) with LAVCARTO of 137 ± 46 ml, which was significantly underestimated with a bias (±1.96 standard deviation) of -31 (-111; +49) ml, -64 (-132; +2) ml, and -49 (-125; +27) ml, respectively; p < 0.0001 for their mutual difference. LA enlargement itself, age, gender, type of AF, and the presence of structural heart disease were independent confounders of measurement error of 2D-echocardiographic LAV.
  
  
  CONCLUSIONS
  Accuracy and precision of all 2D-echocardiographic LAV indices are poor. Their agreement with true LAV can be significantly improved by multivariate adjustment to clinical characteristics of patients.
authors.affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Stepan
authors.initials: S
authors.lastname: Havranek
authors.affiliation: Department of Cardiology, Heart Centre, Hospital Podlesi, Trinec, Czech Republic.|Department of Internal Medicine and Cardiology, University Hospital, Masaryk University, Brno, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Fiala
authors.affiliation: Department of Cardiology, Hospital Ceske Budejovice and Faculty of Health and Social Studies, University of South Bohemia, Ceske Budejovice, Czech Republic.
authors.forename: Alan
authors.initials: A
authors.lastname: Bulava
authors.affiliation: Department of Cardiology, Heart Centre, Hospital Podlesi, Trinec, Czech Republic.
authors.forename: Libor
authors.initials: L
authors.lastname: Sknouril
authors.affiliation: Department of Cardiology, Heart Centre, Hospital Podlesi, Trinec, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Dorda
authors.affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.|Department of Cardiology and Angiology, St. Anne's University Hospital and International Clinical Research Center, Brno, Czech Republic.
authors.forename: Veronika
authors.initials: V
authors.lastname: Bulkova
authors.affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Fingrova
authors.affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Lucie
authors.initials: L
authors.lastname: Souckova
authors.affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Palecek
authors.affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Simek
authors.affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Ales
authors.initials: A
authors.lastname: Linhart
authors.affiliation: 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.|Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Dan
authors.initials: D
authors.lastname: Wichterle
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D012372:ROC Curve; D012044:Regression Analysis