Indexing of Left Atrial Volume by Body Surface Area and Height in a Brazilian Population without Previous Heart Disease and with a Normal Heart on Echocardiography. Behavior in Obese and Overweight Patients.

Background: Left atrial (LA) volume indexing for body surface area (BSA) may underestimate LA size in obese and overweight people. Since LA volume is a risk marker for some cardiovascular events, it is suggested that indexing for height would be an alternative more appropriate method. The aims of this study were to find normal and the best cutoff values for LA volume indexed for height in our population. Methods: Echocardiograms from 2018 to 2021 were reviewed and patients without known cardiac disease and completely normal echocardiograms that had the left atrial volume (LAvol) measured by biplane Simpson's method were included. LAvol was indexed by BSA (ml/m2), by height (LAvol/m), by height raised to exponent 2.7 (ml/ m2.7) and by height squared (ml/h2). Results: A total of 545 patients, 50.5 ± 13.4 y., 335 females (61,5%) were analyzed. There were 145 normal weight (26.6%), 215 overweight (39.4%), 154 obese (28.3%) and 31 low weight (5.7%) patients. To establish normal values we included only the normal weight group and considered normal values from 2SD below to 2SD above the mean. Mean and normal values were: LAvol/h 26.0 ±4.5, 17 - 35 ml/m, LAvol/ht2 16 ± 2.8, 10.4 - 21.6 ml/ ht2 and LAvol/ht2.7 11.4 ± 2.2, 7.0 - 15.8 ml/m2.7. The normal LAvol/ht2.7 differed between male and female (11.4 ± 2.4 and 12.8 ± 2.6, p < 0.001). LA diameter, LAvol, LAvol/h, LAvol/h2 and LAvol/ht2.7 increased progressively from low-weight, normal weight, overweight and obese patients (p< 0.0001), but not LAvol/BSA. When indexing LAvol for height, for height2 and for height2.7 20.8%, 22.7% and 21.4% of the obese patients, respectively, were reclassified as enlarged LA, and 7.4%, 8.8% and 8.4% of the overweight patients as well. Using ROC curve analysis, LAvol/h2 had the highest AUC ant the best predictive value to identify LA enlargement and LAvol/BSA the worst one. Conclusions: Normal values for LAvol indexed for height by three different methods are described in normal individuals. We reinforce that LAvol indexation for BSA underestimates LA size in obese and overweight patients and in these groups, specially, indexing for height2 is probably the best method to evaluate LAvol.

Position statement on indications of echocardiography in adults ­ 2019

In accordance with the "Standards for the Elaboration of Guidelines, Positions and Normations" sanctioned by the Brazilian Society of Cardiology, this document was written to update the "Echocardiography Indication Guidelines" of 2009. The new document is not intended to be a comprehensive review of echocardiography, but rather an indispensable basic guide to support the rational clinical decision-making of the physician requesting the exam for adult patients. Although it considers the recent technological advances of echocardiography, its purpose is not to describe in detail echocardiography methods, but to summarize in a clear and concise way the main situations in which echocardiography brings benefit to the diagnosis and/or therapeutic orientation of the individual. This manuscript chose to highlight the class of recommendation, as described below: Class I: conditions for which there is conclusive evidence or, in the absence thereof, general agreement that the examination procedure is useful and safe. Class II: conditions for which there is conflicting evidence and/or divergence of opinion on the utility and/or safety of the examination. Class-IIa: evidence or opinions favorable to the examination. Most experts approve. Class IIb: utility and/or safety less well established, with divergent opinions. Class III: conditions for which there is evidence or consensus that the examination is not useful and, in some cases, may even be harmful. In addition, the level of evidence was also described, as follows: A: several concordant randomized clinical trials or robust meta-analyses; B: less robust meta-analysis data or single randomized clinical study or observational studies; C: expert opinion.(AU)

Complicações embólicas de trombo móvel em átrio esquerdo na estenose mitral / Free-floating left atrial thrombus with multiple embolic episodes in a patient with mitral stenosis: a case report

Trombo móvel em átrio esquerdo é uma rara complicação da estenose mitral com alto potencial embólico. O presente caso ilustrra esta condição, detectada ao ecocardiograma transtorácico e confirmada ao ecocardiograma transesofágico. A ocorrência de múltiplos episódios embólicos determinou o desfecho fatal. Os autores enfatizam a necessidade do diagnóstico precoce para previnir estas graves complicações embólicas.