July 29, 2020BMC Veterinary ResearchOpen Access

Comparative assessment of left atrial volume in healthy cats by two-dimensional and three-dimensional echocardiography

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Why the study?

Left atrial size is prognostic in feline cardiac pathologies but currently measured using one-dimensional methods, whereas human medicine standardly uses two- and three-dimensional echocardiography.

How do two-dimensional and three-dimensional echocardiographic methods compare for measuring left atrial volume in healthy cats?

Structured PICO

How do two-dimensional and three-dimensional echocardiographic methods compare for measuring left atrial volume in healthy cats?

Population

Healthy cats

Intervention

Two-dimensional (monoplane, biplane) and three-dimensional (triplane, real-time 3D) echocardiography for left atrial volumetry

Comparator

Comparison between different echocardiographic methods (monoplane, biplane, triplane, RT3DE)

Outcome

Left atrial maximum volume (LAMax) and establishment of reference intervalssurrogate

Monoplane and biplane echocardiography are equivalent for measuring left atrial maximum volume in healthy cats, yielding higher volumes than 3D methods, and a common reference range of 1.96 ± 0.54 ml was established.

Limitations

Low RT3DE image quality was the main reason for excluding patients

Implication

Monoplane and biplane methods are equivalent in healthy cats; leaves open 3D validation and disease-state applicability.

Abstract

BACKGROUND: The left atrium (LA) is an important prognostic parameter in cardiac pathologies of cats. Its size is currently measured in one-dimensional methods, while human medicine considers two- and three-dimensional echocardiography as standard. The objectives of this study were to compare monoplane, biplane, triplane and real-time three dimensional echocardiography for volumetric measurement of the left atrium in healthy cats and establish a reference interval for further studies on cats with heart disease. Additionally, the influence of age, sex and weight on left atrial volume (LAV) was tested. RESULTS: One dimensional monoplane Simpson method of discs (SMOD) in the right parasternal four chamber view (r4) and the left apical 2 chamber view (l2) as well as biplane SMOD had no significant difference for left atrial maximum volume (LAMax). They can be used as equivalent in future studies and one common reference range was set up (1.96 ± 0.54 ml). Those three methods produced significantly higher volumes than triplane echocardiography (RTTPE) and real time three dimensional echocardiography (RT3DE) using TomTec® software. LA volumetry with RTTPE and RT3DE-TomTec™ was more feasible than expected, but low RT3DE image quality was the main reason for excluding patients. Neither age nor weight had an influence on LA volume in healthy cats. Male LAV results were only slightly, but in 2D and RTTPE significantly higher than those of female cats with a range of + 10.46% to + 19.58%. CONCLUSIONS: Monoplane, biplane, triplane and real-time three dimensional echocardiography were feasible for LA volumetry in healthy cats and showed acceptable intra- and interobserver variability. One common LAMax reference range for monoplane r4, l2 and biplane SMOD was set up. Raw data can be used for LA volumes and does not need to be correlated with the cat's weight or age. Male cats have only slightly but significantly larger atria than females in 2D and RTTPE. Therefore, under reservation, also sex related limit values were defined.