title: LA Phasic Volumes and Reservoir Function in the Elderly by Real-Time 3D Echocardiography: Normal Values, Prognostic Significance, and Clinical Correlates.
abstract: This study sought to assess the prevalence and prognostic value of abnormalities in left atrial (LA) phasic volumes and reservoir function in a community cohort.
  
  
  
  LA enlargement is associated with adverse cardiovascular outcomes. Real-time 3-dimensional (RT3D) echocardiography allows assessment of LA phasic volumes and reservoir function. However, there is a paucity of data regarding normal values, clinical correlates, and prognostic value of RT3D echocardiography-derived LA phasic volumes and reservoir function, especially in the elderly, a subgroup at high risk for cardiovascular events.
  
  
  
  Left atrial maximum volume (LAVimax), minimum volume (LAVimin), and reservoir function assessed as emptying volume (LAEV), emptying fraction (LAEF), and expansion index (LAEI), were measured by RT3D echocardiography in participants from a community-based cohort study. Cut-off values for LA phasic volumes were derived from a healthy subgroup of participants free of cardiovascular disease and risk factors (n = 142; 66 ± 9 years of age; 55% women). Annual follow-up examinations were performed for cardiovascular outcomes (myocardial infarction, ischemic stroke, and vascular death).
  
  
  
  The cohort included 706 participants (71 ± 9 years of age; 59% women). LAVimaxand LAViminwere not associated with age in the healthy subgroup but progressively increased with age in the entire cohort (p < 0.001). During a median follow-up of 7 years (minimum 0.06, maximum 9.5 years), 78 cardiovascular events occurred. In univariate analysis, LAVimax, LAVimin, and reservoir function parameters were significantly associated with outcome. In multivariate analysis, LAVimin≥20.5 ml/m2(adjusted hazard ratio [aHR]: 1.79; 95% confidence interval [CI]:1.02 to 3.16) and LAEV ≤5.7 ml/m2(aHR: 1.98; 95% CI: 1.02 to 3.85) remained significantly associated with events. LAViminand LA reservoir function showed incremental prognostic value over that of LAVimax.
  
  
  
  LA phasic volumes and reservoir functions assessed by RT3D echocardiography were strong independent predictors of cardiovascular events in a community-based elderly cohort. LAViminand reservoir function assessment may improve cardiovascular outcome prediction over LAVimax.
authors.affiliation: Department of Medicine, Columbia University, New York City, New York. Electronic address: cr2321@cumc.columbia.edu.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.affiliation: Department of Biostatistics, Columbia University, New York City, New York.
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Medicine, Columbia University, New York City, New York.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.affiliation: Department of Neurology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: Departments of Neurology and Epidemiology, Columbia University, New York City, New York.
authors.forename: Mitchell S V
authors.initials: MSV
authors.lastname: Elkind
authors.affiliation: Departments of Neurology and Epidemiology, Columbia University, New York City, New York; Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: Department of Medicine, Columbia University, New York City, New York.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D018572:Disease-Free Survival; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D013997:Time Factors
keywords: 3-dimensional echocardiography; left atrial volume; outcome; reservoir function