Why the study?
Does an echocardiographic left atrial index ≥ 40 mL/m² predict atrial fibrillation and the combined endpoint of death or need for mitral surgery in patients with organic mitral regurgitation?
Does an echocardiographic left atrial index ≥ 40 mL/m² predict atrial fibrillation and the combined endpoint of death or need for mitral surgery in patients with organic mitral regurgitation?
Echocardiographic assessment of left atrial volume using the biplane area-length method is accurate, and an LA index ≥40 mL/m² independently predicts atrial fibrillation, death, or need for mitral surgery in patients with organic mitral regurgitation.
May refine risk stratification in organic MR; leaves open whether LA volume thresholds should guide intervention timing.
AIMS: To define accurate and normal range of echocardiographic left atrial (LA) volume measurement and to assess the prevalence, determinants, and outcome implications of LA enlargement in mitral regurgitation (MR). METHODS AND RESULTS: We prospectively compared LA volume obtained simultaneously by electron beam-computed tomography (EBCT) and by four echocardiographic methods in 33 test patients. Accurate echocardiographic LA volume measurements were obtained only by biplane area-length method with vertical longitudinal-length (r = 0.95, P < 0.0001; 145 +/- 57 vs. 143 +/- 55 mL, P = 0.57). Using this method, the normal range in 100 normal subjects, the physiological determinants and outcome implications of LA enlargement in 320 patients with organic MR were analysed. In normal subjects, indexed to body surface area, LA index (27 +/- 6 mL/m(2)) was not influenced by age or gender and values > or = 40 mL/m(2) were beyond the upper limit of normal. In MR, the most powerful determinants of LA enlargement were higher regurgitant volume (RVol) and atrial fibrillation (AF) (P < 0.0001), followed by older age, female gender, higher left ventricular end-systolic volume, and mass (all P < 0.001). After diagnosis in sinus rhythm, LA index > or = 40 mL/m(2) predicted superiorly and independently to LA diameter the occurrence of AF [adjusted RR 1.48 (1.06-2.16), P < 0.01] and the combined endpoint of death or need for mitral surgery [adjusted RR 1.61 (1.3-2.0), P < 0.0001]. CONCLUSION: LA remodelling can be accurately assessed by echocardiography and LA index > or = 40 mL/m(2) is beyond the normal range. In organic MR, higher LA index is the combined result of multiple physiological effects, provides independent prognostic information, and therefore should be part of a comprehensive echocardiographic examination.
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Messika‐Zeitoun et al. (2007) studied this question.
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