Left atrial maximum volume is a recurrence predictor in lone atrial fibrillation: an acoustic quantification study.
ABSTRACT Predictors of recurrence in lone atrial fibrillation have not been clearly identified. Acoustic quantification (AQ) is a promising method in the assessment of left atrial (LA) volumes. The purpose of the present study was to investigate the potential of LA volumes obtained by standard manual tracing and AQ methods in predicting AF-recurrence after restoring the sinus rhythm in patients with lone AF, and to test the agreement between the two approaches. Standard echocardiography combined with AQ was performed in 28 patients with lone AF one hour after the sinus rhythm was regained, and in 10 controls. LA volumes were determined by conventional manual tracing and AQ methods. AQ waveforms of LA were obtained by drawing a region of interest around the LA border. The agreement of the two methods was tested by Bland-Altman analysis. Patients were followed up for 6 months for the occurrence of AF recurrence. A good correlation was observed between AQ and manual tracing methods in determining both minimal (r=0.59) and maximal (r=0.88) LA volumes. Patients with AF recurrence had a significantly larger maximum LA volume as assessed with both methods (P<0.05 for both). M-mode derived LA dimension and isovolumic relaxation time were additional predictors of recurrence in patients with lone AF. In lone AF, patients prone to recurrence could be predicted by determining LA maximum volume assessed either by AQ or manual tracing methods. AQ provides on-line, accurate estimation of LA volumes.
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ABSTRACT: Atrial fibrillation (AF) is in most patients (approximately 70%) associated with organic heart disease including valvular heart disease, coronary artery disease, hypertension, hypertrophic cardiomyopathy, dilated cardiomyopathy, and congenital heart disease, mostly atrial septal defect in adults. In many chronic conditions, determining whether AF is the result or is unrelated to the underlying heart disease, remains unclear. The list of possible etiologies also include cardiac amyloidosis, hemochromatosis and endomyocardial fibrosis. Other heart diseases, such as mitral valve prolapse (without mitral regurgitation), calcifications of the mitral annulus, atrial myxoma, pheochomocytoma, and idiopathic dilated right atrium may present with AF. Atrial fibrillation may occur in the absence of detectable organic heart disease, the so-called “lone AF”, in about 30% of cases. The term “idiopathic AF” implies the absence of any detectable etiology including hyperthyroidism, chronic obstructive lung disease, overt sinus node dysfunction, and overt or concealed preexcitation (Wolff-Parkinson-White syndrome), only to mention a few of other uncommon causes of AF. The autonomous nervous system may contribute to the occurrence of AF in some patients. AF occurs commonly. In patients with valvular heart disease, AF is common, particularly when the mitral valve is involved. The occurrence of AF is unrelated to the severity of mitral stenosis or mitral regurgitation but is more common in patients with enlarged left atrium and congestive heart failure. In patients with coronary artery disease, AF occurs predominantly in older patients, males, and patients with left ventricular dysfunction. Important predictive factors of AF include hypertension, left ventricular hypertrophy and diabetes. The risk of the development of AF, in an individual patient, is often difficult to assess. Increasing age, presence of valvular heart disease, and congestive heart failure increase the risk of atrial fibrillation.Pacing and Clinical Electrophysiology 09/1997; 20(10):2670 - 2674. · 1.75 Impact Factor
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ABSTRACT: We examined 12 patients aged six months to 76 years by echocardiography to determine left atrial volume. The results were compared with angiographic left atrial volumes calculated by the biplane Simpson's rule method. Three two-dimensional planes were used: precordial long axis, apical two-chamber, and four-chamber. Area outlines were traced using a light pen computational system providing single plane area length estimates of left atrial volume. The two apical left atrial outlines were combined, and Simpson's rule method was used to calculate left atrial volume. M-mode echocardiograms performed on these patients were used to estimate left atrial volume. As the results of covariance analysis showed that there was no significant difference in the line of regression in systole and diastole, these data were pooled for subsequent comparison with angiography. The closest correlation with angiography was the biplane Simpson rule method with the echocardiographic left atrial volume (Y) = 1.0, angiographic volume (X) + 6.3 ml, r = 0.86. The single plane area length estimates also correlated well with angiography, but correction factors were required. M-mode estimates of left atrial volume could only correlate to angiography using a power function y = 3.7 X(1.80), r = 0.69. We conclude that left atrial volume can be determined by two-dimensional echocardiography and that this technique is superior to M-mode echocardiography.Catheterization and Cardiovascular Diagnosis 02/1981; 7(2):165-78.
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ABSTRACT: Previous reports have indicated that echocardiography with automatic boundary detection (ABD) is useful for the noninvasive estimation of left ventricular volume. However, few data exist regarding the measurement of left atrial (LA) volume, which also provides pivotal information in the clinical setting. Therefore, the feasibility of LA volume measurement by ABD in comparison with the manual tracing using modified Simpson's method (SM) was evaluated. Fifty-nine patients with coronary artery-disease with sinus rhythm were examined. Using ABD, a region of interest was set around the LA border and mitral annulus from an apical four-chamber view. The maximal and minimal LA volume (Vmax and Vmin) were measured from the volume waveform. Using the SM, the maximal and minimal LA volume were measured by the manual tracing on frozen frames at the apical four-chamber view. The ABD displayed a curve of LA volume change that consisted of passive emptying, diastasis, and active emptying phases during the left ventricular diastolic period. Under these conditions, the Vmax and Vmin were 43.7 +/- 11.2 ml and 21.1 +/- 7.6 ml, respectively, yielding the volume change of 22.6 +/- 6.0 ml. By the SM, Vmax and Vmin were 43.1 +/- 9.9 ml (r = 0.94, p < 0.0001, y(ABD) = 0.91x (SM) + 3.6) and 22.0 +/- 9.0 ml (r = 0.91, p < 0.0001, y = 0.94x + 0.7), respectively, and the volume change was 22.8 +/- 6.1 ml (r = 0.82, p < 0.0001, y = 0.84x + 3.8). These results indicate that the ABD from the apical four-chamber approach could provide an accurate estimation of LA volume change, suggesting the potential value of this method in assessing LA function, although some technical difficulties need to be further overcome.Japanese Circulation Journal 10/1998; 62(10):755-9.