International Journal of Gerontology
Volume 3, Issue 1 , Pages 53-65, March 2009

Real-Time Three-Dimensional Echocardiography in the Evaluation of Left Atrial Structure and Function in Normal, Aging, Hypertensive and Heart Failure Patients: New Insights into Left Atrial Adaptation and Remodeling

  • Cheng-Ting Tsai

      Affiliations

    • Department of Cardiovascular Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Chung-Lieh Hung

      Affiliations

    • Department of Cardiovascular Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • Co-first author
    • ,
  • Charles Jia-Yin Hou

      Affiliations

    • Department of Cardiovascular Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Charles Jia-Yin Hou, Department of Cardiovascular Medicine, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 104, Taiwan
    • ,
  • Ta-Chuan Hung

      Affiliations

    • Department of Cardiovascular Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Hung-I Yeh

      Affiliations

    • Department of Cardiovascular Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • ,
  • Cheng-Ho Tsai

      Affiliations

    • Department of Cardiovascular Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan

Accepted 11 January 2009.

Article Outline

SUMMARY 

Background

Precise left atrial (LA) volume quantification, representative of LA function, is of extraordinary clinical prognostic value. However, a detailed description of pathophysiology in different disease populations and interactions with aging by real-time three-dimensional echocardiography (RT-3DE) is lacking.

Methods

This study consisted of three protocols: (1) to test the impact of different LA cutting planes on LA volume quantification in different disease populations (n = 61) by RT-3DE; (2) to examine the impact of aging, hypertension (n = 145), the interaction on LA remodeling; and (3) to further depict the LA regional and global remodeling process in different disease entities (n = 68), including heart failure (HF).

Results

Bias and percentage error in LA volume quantification tended to decrease significantly when compared with the automatic border detection method at eight cutting planes. A linear relationship was apparent between maximal LA volume and age in the hypertensive group (r = 0.26, p = 0.03), but not in the normal aging group (r = 0.16, p = 0.19). A significantly reduced pumping fraction and enlarged LA volume was observed in HF patients (p < 0.01), with a trend toward less LA pumping volume (p = 0.1).

Conclusion

Eight cut planes provided sufficient accuracy in LA volume quantification using the RT-3DE method. Compared with normal aging, LA volume tends to increase with higher pumping volume to compensate for impaired left ventricular relaxation in hypertension. Relatively preserved total LA pumping volume may exist in heart failure patients at the expense of further adaptive volume expansion with a subsequently reduced total emptying fraction.

Key Words:  aging , heart failure , hypertension , left atrial function , remodeling , three-dimensional echocardiography

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Kizer JR , Bella JN , Palmieri V , Liu JE , Best LG , Lee ET , et al.   Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: the Strong Heart Study (SHS) . Am Heart J . 2006;151:412–418
  2. Gottdiener JS , Kitzman DW , Aurigemma GP , Arnold AM , Manolio TA . Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons = 65 years of age (the Cardiovascular Health Study) . Am J Cardiol . 2006;97:83–89
  3. Tsang TSM , Abhayaratna WP , Barnes ME , Miyasaka Y , Gersh BJ , Bailey KR , et al.   Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? . J Am Coll Cardiol . 2006;47:1018–1023
  4. Ewy GA , Ulfers L , Hager WD , Rosenfeld AR , Roeske WR , Goldman S . Response of atrial fibrillation to therapy: role of etiology and left atrial diameter . J Electrocardiol . 1980;13:119–123
  5. Chen CH , Nakayama M , Nevo E , Fetics BJ , Maughan WL , Kass DA . Coupled systolic-ventricular and vascular stiffening with age: implications for pressure regulation and cardiac reserve in the elderly . J Am Coll Cardiol . 1998;32:1221–1227
  6. Triposkiadis F , Tentolouris K , Androulakis A , Trikas A , Toutouzas K , Kyriakidis M , et al.   Left atrial mechanical function in the healthy elderly: new insights from a combined assessment of changes in atrial volume and trans-mitral flow velocity . J Am Soc Echocardiogr . 1995;8:801–809
  7. Simek CL , Feldman MD , Haber HL , Wu CC , Jayaweera AR , Kaul S . Relationship between left ventricular wall thickness and left atrial size: comparison with other measures of diastolic function . J Am Soc Echocardiogr . 1995;8:37–47
  8. Thomas L , Levett K , Boyd A , Leung DY , Schiller NB , Ross DL . Compensatory changes in atrial volumes with normal aging: is atrial enlargement inevitable? . J Am Coll Cardiol . 2002;40:1630–1635
  9. Kühl HP , Schreckenberg M , Rulands D , Katoh M , Schäfer W , Schummers G , et al.   High-resolution transthoracic realtime three-dimensional echocardiography: quantitation of cardiac volumes and function using semi-automatic border detection and comparison with cardiac magnetic resonance imaging . J Am Coll Cardiol . 2004;43:2083–2090
  10. Corsi C , Lang RM , Veronesi F , Weinert L , Caiani EG , MacEneaney P , et al.   Volumetric quantification of global and regional left ventricular function from real-time three-dimensional echocardiographic images . Circulation . 2005;112:1161–1170
  11. Li F , Wang Q , Yao GH , Zhang PF , Ge ZM , Zhang M , et al.   Impact of the number of image planes of real-time three-dimensional echocardiography on the accuracy of left atrial and ventricular volume measurements . Ultrasound Med Biol . 2008;34:40–46
  12. Voormolen MM , Krenning BJ , van Geuns RJ , Borsboom J , Lancée CT , ten Cate FJ , et al.   Efficient quantification of the left ventricular volume using 3-dimensional echocar-diography: the minimal number of equiangular long-axis images for accurate quantification of the left ventricular volume . J Am Soc Echocardiogr . 2007;20:373–380
  13. Jacobs LD , Salgo IS , Goonewardena S , Weinert L , Coon P , Bardo D , et al.   Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data . Eur Heart J . 2006;27:460–468
  14. Jenkins C , Bricknell K , Marwick TH . Use of real-time three-dimensional echocardiography to measure left atrial volume: comparison with other echocardiographic techniques . J Am Soc Echocardiogr . 2005;18:991–997
  15. de Simone G , Devereux RB , Ganau A , Hahn RT , Saba PS , Mureddu GF , et al.   Estimation of left ventricular chamber and stroke volume by limited M-mode echocardiog-raphy and validation by two-dimensional and Doppler echocardiography . Am J Cardiol . 1996;78:801–807
  16. Anwar AM , Soliman OI , Geleijnse ML , Nemes A , Vletter WB , ten Cate FJ . Assessment of left atrial volume and function by real-time three-dimensional echocardiog-raphy . Int J Cardiol . 2008;123:155–161
  17. Triposkiadis F , Trikas A , Pitsavos C , Papadopoulos P , Toutouzas P . Relation of exercise capacity in dilated cardiomyopathy to left atrial size and systolic function . Am J Cardiol . 1992;70:825–827
  18. Benjamin EJ , Levy D , Vaziri SM , D'Agostino RB , Belanger AJ , Wolf PA . Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham Heart Study . JAMA . 1994;271:840–844
  19. Prystowsky EN , Benson DW , Fuster V , Hart RG , Kay GN , Myerburg RJ , et al.   Management of patients with atrial fibrillation: a statement for healthcare professionals from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association . Circulation . 1996;93:1262–1277
  20. Triposkiadis F , Harbas C , Kelepeshis G , Sitafidis G , Skoularigis J , Demopoulos V , et al.   Left atrial remodeling in patients younger than 70 years with diastolic and systolic heart failure . J Am Soc Echocardiogr . 2007;20:177–185
  21. Pagel PS , Kehl F , Gare M , Hettrick DA , Kersten JR , Warltier DC . Mechanical function of the left atrium: new insights based on analysis of pressure-volume relations and Doppler echocardiography . Anesthesiology . 2003;98:975–994
  22. Spencer KT , Mor-Avi V , Gorcsan J , DeMaria AN , Kimball TR , Monaghan MJ , et al.   Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study . Heart . 2001;85:272–277
  23. Tirrito SJ , Augustine DR , Kerut EK . How to measure left atrial volume . Echocardiography . 2004;21:569–571
  24. Bauer F , Shiota T , White RD , Lever HM , Qin JX , Drinko J , et al.   Determinant of left atrial dilation in patients with hypertrophic cardiomyopathy: a real-time three-dimensional echocardiographic study . J Am Soc Echo-cardiogr . 2004;17:968–975
  25. Vandenberg BF , Weiss RM , Kinzey J , Acker M , Stark CA , Stanford W , et al.   Comparison of left atrial volume by two-dimensional echocardiography and cine-computed tomography . Am J Cardiol . 1995;75:754–757
  26. Sievers B , Addo M , Kirchberg S , Bakan A , John-Puthenveettil B , Franken U , et al.   How much are atrial volumes and ejection fractions assessed by cardiac magnetic resonance imaging influenced by the ECG gating method? . J Cardiovasc Magn Reson . 2005;7:587–593
  27. Mannaerts HF , Van Der Heide JA , Kamp O , Papavassiliu T , Marcus JT , Beek A , et al.   Quantification of left ventricular volumes and ejection fraction using freehand transtho-racic three-dimensional echocardiography: comparison with magnetic resonance imaging . J Am Soc Echocar-diogr . 2003;16:101–109
  28. Suh IW , Song JM , Lee EY , Kang SH , Kim MJ , Kim JJ , et al.   Left atrial volume measured by real-time 3-dimensional echocardiography predicts clinical outcomes in patients with severe left ventricular dysfunction and in sinus rhythm . J Am Soc Echocardiogr . 2008;21:439–445
  29. Alsaileek AA , Osranek M , Fatema K , McCully RB , Tsang TS , Seward JB . Predictive value of normal left atrial volume in stress echocardiography . J Am Coll Cardiol . 2006;47:1024–1028
  30. Sohn DW , Chai IH , Lee DJ , Kim HC , Kim HS , Oh BH , et al.   Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function . J Am Coll Cardiol . 1997;30:474–480
  31. Zhang Q , Yip GWK , Yu CM . Approaching regional left atrial function by tissue Doppler velocity and strain imaging . Europace . 2008;10(Suppl 3):iii62–iii69
  32. Hoit BD , Walsh RA . Regional atrial distensibility . Am J Physiol . 1992;262:H1536–H1560

PII: S1873-9598(09)70021-3

doi:10.1016/S1873-9598(09)70021-3

International Journal of Gerontology
Volume 3, Issue 1 , Pages 53-65, March 2009

Article Tools