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1.
Am J Cardiol ; 151: 105-113, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34049674

RESUMO

Left atrial (LA) enlargement predicts adverse cardiovascular events in patients with chronic kidney disease (CKD). The aim of our study was to evaluate the value of LA reservoir strain, a novel measure of LA function, as a prognostic marker for adverse renal outcomes. A total of 280 patients (65.8 ± 12.2years, 63% male) with stable Stage 3 and 4 CKD without prior cardiac history were evaluated with transthoracic echocardiography and prospectively followed for up to 5 years. The primary end point was progressive renal failure, which was the composite of death from renal cause, end-stage renal failure and/or doubling of serum creatinine. Over a mean follow up of 3.9 ± 2.7years, 56 patients reached the composite endpoint. By log rank test, older age, lower baseline eGFR, anemia, diabetes mellitus, higher urinary albumin/creatinine ratio, number of antihypertensive medications, higher indexed left ventricular mass, larger LA volumes, and impaired LA reservoir strain were significant predictors of the composite outcome (p <0.01 for all). Multi-variable Cox regression analysis found LA reservoir strain, eGFR, number of antihypertensive medications and urinary albumin/creatinine ratio were independent predictors for progressive renal failure (p <0.01 for all). Impaired LA reservoir strain was associated with a 2.5-fold higher risk of the composite outcome (HR 2.51, 95% CI 1.19 to 5.30, p = 0.02) and was the only echocardiographic parameter that predicted progressive renal failure independent of established clinical risk factors for end-stage renal failure. Its utility requires validation in high risk CKD patients with cardiac disease.


Assuntos
Função do Átrio Esquerdo , Átrios do Coração/diagnóstico por imagem , Falência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Idoso , Creatinina/sangue , Progressão da Doença , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/fisiopatologia , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/mortalidade
2.
J Am Soc Echocardiogr ; 34(2): 166-175, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33223356

RESUMO

BACKGROUND: Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events, which is underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients. METHODS: Two hundred forty-three prospectively recruited stage 3/4 CKD patients (male, 63%; mean age, 59.2 ± 14.4 years) without previous cardiac disease made up the study cohort. All participants underwent a transthoracic echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for 3.9 ± 2.7 years for the primary end point of cardiovascular death and major adverse cardiovascular event (MACE). The secondary end point was the composite of all-cause death and MACE. RESULTS: Fifty-four patients met the primary end point, and 65 the secondary end point. On log-rank tests, older age, diabetes mellitus, anemia, greater LV mass, reduced LV global longitudinal strain, larger indexed LA volume, higher E/e' ratio, and reduced LA reservoir strain (LASr; P < .01 for all) were independent predictors of cardiovascular death and MACE. On multivariable regression analysis of univariate predictors, LASr (P < .01) was the only independent predictor for the primary end point as well as for the secondary end point. Receiver operating characteristic curve analysis showed LASr was a stronger predictor of adverse events (area under the curve [AUC] = 0.84) compared to the Framingham (AUC = 0.58) and Atherosclerotic Cardiovascular Disease (AUC = 0.59) risk scores. CONCLUSIONS: LASr is an independent predictor of cardiovascular death and MACE in CKD patients, superior to clinical risk scores, LV parameters, and LA volume.

3.
J Am Heart Assoc ; 10(1): e017840, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33372523

RESUMO

Background Left atrial (LA) function plays a pivotal role in modulating left ventricular performance. The aim of our study was to evaluate the relationship between resting LA function by strain analysis and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its utility compared with exercise E/e'. Methods and Results Consecutive patients with stage 3 and 4 CKD without prior cardiac history were prospectively recruited from outpatient nephrology clinics and underwent clinical evaluation and resting and exercise stress echocardiography. Resting echocardiographic parameters including E/e' and phasic LA strain (LA reservoir [LASr], conduit, and contractile strain) were measured and compared with exercise E/e'. A total of 218 (63.9±11.7 years, 64% men) patients with CKD were recruited. Independent clinical parameters associated with exercise capacity were age, estimated glomerular filtration rate, body mass index, and sex (P<0.01 for all), while independent resting echocardiographic parameters included E/e', LASr, and LA contractile strain (P<0.01 for all). Among resting echocardiographic parameters, LASr demonstrated the strongest positive correlation to metabolic equivalents achieved (r=0.70; P<0.01). Receiver operating characteristic curves demonstrated that LASr (area under the curve, 0.83) had similar diagnostic performance as exercise E/e' (area under the curve, 0.79; P=0.20 on DeLong test). A model combining LASr and clinical metrics showed robust association with metabolic equivalents achieved in patients with CKD. Conclusions LASr, a marker of decreased LA compliance is an independent correlate of exercise capacity in patients with stage 3 and 4 CKD, with similar diagnostic value to exercise E/e'. Thus, LASr may serve as a resting biomarker of functional capacity in this population.

4.
Echocardiography ; 37(12): 2018-2028, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33211337

RESUMO

BACKGROUND: Left atrial (LA) deformation during the reservoir phase (LASr) has demonstrated strong prognostic value in different clinical settings. Although determinants of left atrial reservoir strain including left atrial relaxation, left atrial compliance, and left ventricular longitudinal systolic function are fairly well defined, there is incomplete information regarding the effect of left atrial volume on this relationship which is the focus of our study. METHOD: Consecutive patients without prior cardiac disease referred for transthoracic echocardiography were prospectively recruited. All participants underwent clinical assessment, transthoracic echocardiography (TTE), and screening exercise stress test. Only patients with normal left ventricular ejection fraction (LVEF) without left ventricular hypertrophy (LVH) or myocardial ischemia on stress testing were included. RESULTS: A total of 260 patients (57% male, mean age 59 ± 14 years) were included. 70% had hypertension, 33% had diabetes mellitus, and 31% had both HTN and DM. On multivariate analysis, age, e', LAVI, and LV GLS (P < .01 for all) showed an independent association with LASr. Of interest, at lower tertiles of LAVI, a linear decrease in LASr was observed parallel to worsening LV GLS, whilst at higher tertiles of LAVI, the reduction in LASr was non-linear implying that LA enlargement, consequent to LA remodeling, had an incremental effect on LASr. CONCLUSION: Age, e', LV GLS, and LAVI were independently associated with LASr. LA remodeling reflected by larger LAVI had an incremental negative association with LASr independent of LV GLS.


Assuntos
Função do Átrio Esquerdo , Disfunção Ventricular Esquerda , Idoso , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda
5.
JACC Cardiovasc Imaging ; 13(12): 2485-2494, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32861659

RESUMO

OBJECTIVES: This study sought to assess the relationship between E/e' and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its prognostic role. BACKGROUND: Patients with CKD have diastolic dysfunction, reduced physical fitness, and elevated risk of cardiovascular disease. METHODS: Patients with stage 3 and 4 CKD without previous cardiac disease underwent resting and exercise stress echocardiograms with assessment of exercise E/e'. Patients were compared to age-, sex-, and risk factor-matched control individuals and were followed annually for 5 years for cardiovascular death and major adverse cardiovascular event(s) (MACE). Exercise capacity was assessed as metabolic equivalents (METs), with reduced exercise capacity defined as METs of ≤7. Raised exercise E/e' was defined as >13. RESULTS: A total of 156 patients with CKD (age 62.8 ± 10.6 years; male: 62%) were compared to 156 matched control individuals. Patients with CKD were more likely to be anemic (p < 0.01) and had increased left ventricular mass (p < 0.01), larger left atrial volumes (p < 0.01), and higher resting (p < 0.01) and exercise E/e' (p < 0.01). Patients with CKD achieved lower exercise METs (p < 0.01), and more patients with CKD had METs of ≤7 (p < 0.01). Receiver-operating characteristic curves showed exercise E/e' (area under the curve [AUC]: 0.89; 95% CI: 0.84 to 0.95; p < 0.01) as the strongest predictor of reduced exercise capacity in patients with CKD. Over a follow-up period of 41.4 months, a raised exercise E/e' of >13 was an independent predictor of cardiovascular death and MACE on unadjusted and adjusted hazard models. CONCLUSION: E/e' is a strong predictor of exercise capacity and METs achieved by patients with CKD. Exercise capacity was reduced in patients with CKD, presumably consequent to diastolic dysfunction. Elevated exercise E/e' in patients with CKD is an independent predictor of cardiovascular death and MACE.

6.
Heart Lung Circ ; 24(7): e81-5, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25778624

RESUMO

BACKGROUND: The left atrial appendage (LAA) is a vestigial structure located in the postero-lateral aspect of the left atrium. Aneurysmal enlargement of the LAA is pathological and can predispose to adverse events, including myocardial infarction, atrial fibrillation and systemic thromboembolism. The condition is rare and usually isolated, occurring in the absence of other cardiac defects. In this cardiac vignette, we describe a case of giant left atrial appendage in a middle aged female presenting with chest pain and explore the natural history, different investigative modalities as well as issues in clinical management of this condition.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia , Ultrassonografia
7.
Heart Lung Circ ; 23(11): e248-50, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25127669

RESUMO

Isolated pulmonary regurgitation (PR) is a rare occurrence with only a handful of documented cases worldwide. Though usually well tolerated in childhood, chronic PR can eventually lead to RV dysfunction and ventricular arrhythmias. In this cardiac vignette, we describe a case of isolated PR in a young female presenting with syncope and explore the natural history, different investigative modalities as well as issues in clinical management of this rare condition.


Assuntos
Insuficiência da Valva Pulmonar , Síncope , Adulto , Feminino , Humanos , Insuficiência da Valva Pulmonar/complicações , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/cirurgia , Radiografia , Síncope/complicações , Síncope/diagnóstico por imagem , Síncope/cirurgia , Ultrassonografia
8.
Heart Lung Circ ; 22(9): 778-80, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24054492

RESUMO

Poland syndrome is a rare congenital abnormality with an estimated incidence of 1 in 20,000 to 1 in 30,000 live births. We report and discuss this rare combination of pulmonary hypertension and dextrocardia with Poland syndrome. This case report also highlights the underlying pathogenetic mechanisms during foetal development and the potential to misdiagnose cardiac ischaemia in a patient with an anatomic anomaly.


Assuntos
Dextrocardia , Erros de Diagnóstico , Hipertensão Pulmonar , Isquemia Miocárdica , Síndrome de Poland , Dextrocardia/complicações , Dextrocardia/diagnóstico , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Síndrome de Poland/complicações , Síndrome de Poland/diagnóstico
9.
J Am Soc Hypertens ; 7(2): 149-56, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23428410

RESUMO

Hypertension (HT) is associated with left ventricular (LV) diastolic dysfunction and consequent left atrial (LA) dilatation. We investigated changes in LA size and phasic function by decade in patients with HT. Patients with mild or moderate HT (n = 122) were compared with a case controlled normal cohort (blood pressure <140/90 mm Hg). Biplane LA maximum, minimum, and pre 'a' wave volumes were measured; LA filling, passive emptying, and active emptying volumes and fractions were calculated. Transmitral inflow and pulsed wave mitral annular tissue Doppler velocity were measured as expressions of LV diastolic function. The HT group had larger LA maximum volumes compared with normal controls for all decades until the 8th decade. Subjects with HT in decade 4 had LA maximum volume similar to that of normal controls from decade 8 (27.8 ± 4.3 mL/m(2) vs 25.6 ± 6.1 mL/m(2) respectively, P = .22). Active emptying volume and fraction were higher in the HT group across all decades, while there was no difference between the HT and normal groups for passive emptying volume. LV mass and E/E' ratio were significantly higher across all decades in the HT group. HT alters atrial dynamics significantly, with resultant increased LA volume and active emptying volume consequent to altered LV diastolic function. HT 'accelerates' the normal aging process with patients as early as decade 4 having similar LA size to that of normal controls in decade 8. This premature increase in LA volume may result in the future development of atrial fibrillation in HT patients.


Assuntos
Envelhecimento/fisiologia , Átrios do Coração/fisiopatologia , Hipertensão/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Ecocardiografia Doppler , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão
10.
Eur Heart J Cardiovasc Imaging ; 13(12): 1016-23, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22544873

RESUMO

AIM: To evaluate left atrial (LA) volume and function as assessed by strain and strain rate derived from 2D speckle tracking and their association with diastolic dysfunction (DD) in patients with diabetes mellitus (DM). METHODS AND RESULTS: Seventy three patients with DM were compared with age- and gender-matched normal controls; 30 patients with DM alone were compared to those with hypertension (HT) alone. The maximum LA volume, traditional measures of atrial function, 2D strain and strain rate were analysed. The LA indexed volume (LAVI) was larger in DM group than that in normal controls (38.2 ± 9.9 vs. 20.5 ± 4.8 ml/m(2), P< 0.0001), as well as in DM alone compared with hypertensive patients (33.9 ± 10 vs. 25.7 ± 8 ml/m(2), P< 0.0001). Global strain was significantly reduced in the DM group compared with that in normal controls (22.5 ± 8.67 vs. 30.6 ± 8.27%; P< 0.0001) but was similar with HT. There was a weak correlation between LAVI and global strain with increasing grades of DD (r= 0.439, P< 0.0001 and r= - 0.316, P< 0.0001, respectively) in the diabetic group. However, there was no significant difference in LAVI between these groups. A logistic regression analysis for predictors of LAVI demonstrated that only diabetes was a determinant of LAVI. Patients with diabetes showed a significant reduction in global strain compared with normal controls but no difference with increasing grades of diastolic function. CONCLUSIONS: LA enlargement in DM is independent of associated HT and diastolic function. LA enlargement is associated with LA dysfunction as evaluated by 2D strain. It is likely that a combination of DD and a diabetic atrial myopathy contribute to LA enlargement in patients with DM.


Assuntos
Função do Átrio Esquerdo , Diabetes Mellitus/fisiopatologia , Ecocardiografia/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Adulto , Análise de Variância , Estudos de Casos e Controles , Diástole , Feminino , Humanos , Hipertensão/fisiopatologia , Interpretação de Imagem Assistida por Computador , Modelos Logísticos , Masculino
11.
Am J Cardiol ; 107(2): 290-6, 2011 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-21129716

RESUMO

The aim of this study was to determine if left atrial (LA) phasic function evaluated by Doppler tissue imaging-derived strain and strain rate would be differentially decreased in patients with hypertrophic cardiomyopathy (HC) compared to patients with hypertension and to normal controls. Thirty-seven patients with HC were compared to 44 patients with systemic hypertension (SH) and 65 normal controls using transthoracic echocardiography. Maximal and minimal LA volume and LA volume just before active atrial contraction (pre-P LA volume) were measured, and phasic LA volumes were calculated. Global and segmental systolic strain rate, early diastolic strain rate, and late diastolic strain rate (A-Sr) and strain were measured from Doppler tissue imaging. Left ventricular mass was increased in the HC and SH groups compared to normal controls, but diastolic dysfunction was greater in the HC group. LA volumes were increased in patients with HC compared to those with SH and to normal controls, with corresponding reductions in A-Sr and atrial strain in the HC group. In contrast, only early diastolic strain rate was decreased in the SH group compared to controls. A-Sr remained reduced in patients with HC compared to the SH group, even after adjusting for left ventricular mass. When left ventricular mass, parameters of diastolic function (peak E and E' velocity), and the effect of patient group (SH vs HC) were examined in a stepwise regression model, patient group (SH vs HC) was the only independent determinant of A-Sr. In conclusion, HC results in LA enlargement with reduced LA phasic function that is reflected in reductions in A-Sr and atrial strain. Atrial enlargement is a likely consequence of the greater diastolic dysfunction in the HC group.


Assuntos
Função do Átrio Esquerdo/fisiologia , Cardiomiopatia Hipertrófica/fisiopatologia , Ecocardiografia Doppler em Cores/métodos , Átrios do Coração/diagnóstico por imagem , Hipertensão/fisiopatologia , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Feminino , Seguimentos , Átrios do Coração/fisiopatologia , Humanos , Hipertensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
12.
J Am Soc Echocardiogr ; 23(5): 538-44, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20226627

RESUMO

BACKGROUND: The aim of this study was to evaluate whether maximal left atrial (LA) volume and phasic atrial function would be further altered in patients with hypertrophic cardiomyopathy (HCM) compared with patients with systemic hypertension (HT) with similar left ventricular (LV) mass. LA enlargement on echocardiography has been documented in HCM and moderate or severe HT, both conditions causing LV hypertrophy. METHODS: Thirty-five patients with HCM were compared with patients with HT matched for LV mass and normal controls matched for age and gender. Maximal, minimal, and pre-"p" LA biplane and real-time 3-dimensional volumes and LA phasic function were evaluated. Atrial function was estimated by LA ejection force, atrial fraction, and A' velocity. RESULTS: Maximal, minimal, and pre-"p" LA volumes were significantly increased in the HCM group compared with the HT group and controls. Additionally, LA phasic volumes demonstrated that conduit volume and total, passive, and active emptying fractions were decreased in the HCM group. Despite similar LV mass, the HCM group had a higher incidence of abnormal diastolic filling (60% vs 34%, P = .001). CONCLUSIONS: Patients with HCM appeared to have larger LA volumes, poorer LA function, and greater severity of diastolic dysfunction compared with those with HT having comparable LV mass. LA changes may be due to coexistent atrial myopathy associated with other pathophysiologic aspects of HCM, including outflow obstruction, mitral regurgitation, and myocardial fibrosis in HCM.


Assuntos
Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Hipertensão/complicações , Hipertensão/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão
13.
Circ Cardiovasc Imaging ; 2(2): 93-9, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19808574

RESUMO

BACKGROUND: Left atrial (LA) enlargement has been documented to occur in moderate and severe hypertension. METHODS AND RESULTS: One hundred twelve mild hypertension patients were prospectively recruited and compared with 198 healthy volunteers. All recruits had a transthoracic echocardiogram. Maximum LA biplane volume, minimum LA biplane volume, and pre 'p'-LA biplane volume were measured, and left atrial passive, active emptying, and conduit volumes were calculated at baseline and in a subgroup of patients after 12 months. After adjusting for age, gender, and body mass index, maximum LA biplane volume, pre 'p'-LA biplane volume, and their indexed volumes were increased in the hypertension group. Active emptying volume and fraction were significantly increased in the hypertension group, with no change in conduit and passive volumes. Subgroup analysis comparing hypertensives with normal/mildly increased left ventricular mass (group 1) with those with moderate/severely increased left ventricular mass (group 2) at baseline demonstrated that maximum LA biplane volume (62.8+/-17.9 mL versus 45.4+/-13.7 mL; P<0.001) was significantly increased in group 2. Active emptying volume was also increased. CONCLUSIONS: Even mild hypertension seems to be associated with a reduction in early diastolic filling. This results in augmented late left ventricular diastolic filling due to active atrial contraction and may be the mechanism for the increase in left atrial size.


Assuntos
Função do Átrio Esquerdo , Hipertensão/fisiopatologia , Diástole , Ecocardiografia , Ecocardiografia Doppler , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico por imagem , Hipertensão/tratamento farmacológico , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etiologia , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Função Ventricular Esquerda
14.
Pacing Clin Electrophysiol ; 31(9): 1095-9, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18834458

RESUMO

OBJECTIVES: We assessed the efficacy of antitachycardia pacing (ATP) and low-energy (5J) shock for very fast ventricular tachycardia (VFVT), cycle length 200-250 ms, in patients with implantable cardioverter defibrillators (ICDs). METHODS AND RESULTS: One hundred and fifty-two consecutive patients with standard indications for ICD therapy were enrolled. Before discharge from the hospital each patient had an electrophysiological study (EPS) performed through the device, to assess the efficacy of ATP and low-joule shock at terminating VFVT. Initial therapy for VFVT consisted of three bursts of ATP followed by low-energy shock, and high-energy shocks as required. The mean age of enrolled patients was 63 +/- 13 years, and the mean left ventricular ejection fraction (LVEF) was 31 +/- 13%. During the predischarge EPS, a total of 125 VT episodes were induced in 64 patients. In patients with VFVT, the success rate of ATP was 30% (14/46), the acceleration rate was 26% (12/46), and the success rate of low-energy shock was 86% (25/29). In patients with fast ventricular tachycardia (FVT), cycle lengths 251-320 ms, the success rate of ATP was 62% (24/39), the acceleration rate was 18% (7/39), and the success rate of low-energy shock was 94% (17/18). CONCLUSIONS: This study has demonstrated for the first time that ATP and low-energy shock are effective, as an alternative to high-energy shock, to revert induced VFVT. Low-energy shock has a very high success rate for VT slower than VFVT. Clinical studies are required prior to consideration for empiric programming.


Assuntos
Estimulação Cardíaca Artificial/métodos , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/prevenção & controle , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
Heart Lung Circ ; 17(2): 100-6, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17913582

RESUMO

BACKGROUND: There is no well established measurement of left atrial (LA) size on transoesophageal echocardiography (TOE). We sought to determine which measurement on TOE would best correlate with LA size obtained from transthoracic echocardiography (TTE). METHODS: LA diameter (LAD) and volume (LAV) on TOE were compared to TTE measurements from 57 patients. The transthoracic examination was performed just prior to the TOE under 'similar clinical conditions'. LAD was obtained by M-mode and LAV was estimated by area-length method, M-mode derived LAD and the Simpson's method on TOE and compared to LAV estimated by the Simpson's method on transthoracic examination. RESULTS: Despite LAD and LAV being underestimated on TOE, good correlations were present between LAD (r=0.85; p=0.001), area-length LAV (r=0.72; p=0.001) and Simpson's LAV (r=0.8; p=0.001). Bland Altman analysis for comparison of LAD between transoesophageal and transthoracic measurements demonstrated a mean difference of -2mm. Simpson's LAV on TOE gave the best estimation of LAV from TTE with a mean difference of -6 ml as compared to -10 ml by area-length LAV in the cohort studied. CONCLUSION: Both left atrial diameter and volume are underestimated on TOE. The best measure with the least under-estimation of LA volume on transoesophageal examination as compared to TTE measures is obtained from Simpson's biplane estimation of LA volume.


Assuntos
Pesos e Medidas Corporais/métodos , Ecocardiografia Transesofagiana/métodos , Átrios do Coração/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador
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