Determinants of discrepancies between two-dimensional echocardiographic methods for assessment of maximal left atrial volume.
OBJECTIVE
The determinants of discrepancies among two-dimensional echocardiographic (2D-E) methods for left atrial volume (LAV) assessment are poorly investigated.


RESULTS
Maximal LAV was measured in 613 individuals (282 healthy subjects,180 athletes, and 151 hypertensives; age 45 ± 20 years, 62% male) using the ellipsoid model (LAVEllips), the area-length method (LAVAL), and the Simpson's rule (LAVSimps). On the basis of a mathematical model, two left atrial (LA) geometry indexes were tested as predictors of discrepancies between methods: the ratio between LA medial-lateral diameter (MLD) and LA anteroposterior diameter (APD); and the ratio between LA area in the four-chamber view and that of an ellipse with the same diameters [deviation from ellipse (DE)-coefficient]. Discrepancies among methods were consistently present in the overall population and across all study groups. MLD/APD and the DE-coefficient together predicted 76 and 68% of differences between biplane LAVAL and LAVEllips, and between biplane LAVSimps and LAVEllips, respectively. The DE-coefficient was the only determinant of LAVAL/LAVSimps difference (β = 0.167, P < 0.0001). Body mass index was the strongest predictor of discrepancies between single-plane and biplane approaches of LAVAL (β = 0.427, P < 0.0001) and LAVSimps (β = 0.424, P < 0.0001). In additional analyses, biplane LAVAL showed the best agreement with LAV obtained by three-dimensional echocardiography and the best reproducibility and repeatability.


CONCLUSIONS
LA geometry is the main determinant of inconsistencies between 2D-E methods for measuring maximal LAV. Body mass index is the strongest determinant of differences between single-plane and biplane approaches. Different 2D-E methods cannot be used interchangeably for diagnosis and follow-up. The biplane area-length method should be preferred, particularly in overweight-obese subjects.
Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy.
Piercarlo
P
Ballo
CMSR Veneto Medica, Altavilla Vicentina, Italy.
Stefano
S
Nistri
Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
Maurizio
M
Galderisi
Department of Cardiology, University of Ferrara, Ferrara, Italy.
Donato
D
Mele
Cardiology Division, Borgo Trento Hospital, Verona, Italy.
Andrea
A
Rossi
Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
Frank L
FL
Dini
Careggi University Hospital, Referral Center for Cardiomyopathies, Florence, Italy.
Iacopo
I
Olivotto
Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy.
Maria Angela
MA
Losi
Department of Cardiology, Second University of Naples, Naples, Italy.
Antonello
A
D'Andrea
Regional Health Agency of Tuscany, Florence, Italy.
Alfredo
A
Zuppiroli
Cardiology Unit, Nuovo S. Giovanni di Dio Hospital, Florence, Italy.
Giovanni Maria
GM
Santoro
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
Sergio
S
Mondillo
Centro Medico Diagnostico, Naples, Italy.
Federico
F
Gentile
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D056352:Athletes; D016279:Atrial Function, Left / Q000502:physiology*; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D012016:Reference Values
Echocardiography; Left atrial geometry; Left atrial volume