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Comparative Study
. 2010 Sep;23(9):954-60.
doi: 10.1016/j.echo.2010.06.010. Epub 2010 Jul 21.

Comparison of echocardiographic single-plane versus biplane method in the assessment of left atrial volume and validation by real time three-dimensional echocardiography

Cesare Russo  1 , Rebecca T Hahn, Zhezhen Jin, Shunichi Homma, Ralph L Sacco, Marco R Di Tullio
Affiliations
Comparative Study

Comparison of echocardiographic single-plane versus biplane method in the assessment of left atrial volume and validation by real time three-dimensional echocardiography

Cesare Russo et al. J Am Soc Echocardiogr. 2010 Sep.

Abstract

Background: The American Society of Echocardiography recommends calculating left atrial (LA) biplane volume because of its greater accuracy and prognostic value over LA diameter. However, biplane methods are not always feasible. The aim of this study was to assess the correlation between the echocardiographic LA biplane and single-plane volumes and their agreement in the classification of LA size when American Society of Echocardiography cutoffs are applied.

Methods: Two-dimensional echocardiography was performed on the participants of the population-based Cardiovascular Abnormalities and Brain Lesions study. LA volume was calculated by the biplane area-length and single-plane modified Simpson's methods and validated against three-dimensional echocardiography.

Results: The study sample consisted of 527 participants (mean age 69.6 +/- 9.7 years; 61.9% women). Both single-plane and biplane LA volumes correlated well with three-dimensional echocardiography (r = 0.93, P < .001). The correlation between the single-plane and biplane methods was excellent (r = 0.95, P < .001; intraclass correlation coefficient, 0.92; 95% confidence interval, 0.80-0.96). Categorical agreement between the single-plane and biplane methods was modest (kappa = 0.51; 95% confidence interval, 0.45-0.57; disagreement rate, 26.0%), mainly because of overestimation by the single-plane method. The correction of the single-plane volume by a regression equation improved the agreement (kappa = 0.70; 95% confidence interval, 0.64-0.76), but misclassifications remained in 14.0% of cases.

Conclusions: Single-plane and biplane LA volume measurements have strong correlations, but their agreement for categorical classification is suboptimal. Specific cutoff points should be developed for the single-plane method.

Keywords: Echocardiography; Left atrium; Volume; biplane; single plane; three-dimensional.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1. Left atrial volume measurement
(A) Biplane area-length method. The LA planimetry is performed in 4-chamber view (A I) and 2-chamber view (A II). (B) Modified single-plane Simpson’s rule. The volume is calculated assuming the stacked disks are circular. ESV: End-systolic volume; BP: Biplane.
Figure 2
Figure 2
Correlations of 3D with biplane LA volume (A) and with single-plane LA volume (B).
Figure 2
Figure 2
Correlations of 3D with biplane LA volume (A) and with single-plane LA volume (B).
Figure 3
Figure 3
Relation between biplane LA volume and single-plane volume (A) and antero-posterior diameter (B).
Figure 3
Figure 3
Relation between biplane LA volume and single-plane volume (A) and antero-posterior diameter (B).
Figure 4
Figure 4
Bland-Altman plots showing the agreement between: (A) Biplane vs. single-plane LA volume; (B) Biplane vs. corrected single-plane LA volume.
Figure 4
Figure 4
Bland-Altman plots showing the agreement between: (A) Biplane vs. single-plane LA volume; (B) Biplane vs. corrected single-plane LA volume.
See this image and copyright information in PMC

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References

    1. Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol. 2002;90:1284–1289. - PubMed
    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. - PubMed
    1. Tsang TS, Barnes ME, Bailey KR, Leibson CL, Montgomery SC, Takemoto Y, et al. Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc. 2001;76:467–475. - PubMed
    1. Takemoto Y, Barnes ME, Seward JB, Lester SJ, Appleton CA, Gersh BJ, et al. Usefulness of left atrial volume in predicting first congestive heart failure in patients > or = 65 years of age with well-preserved left ventricular systolic function. Am J Cardiol. 2005;96:832–836. - PubMed
    1. Di Tullio MR, Sacco RL, Sciacca RR, Homma S. Left atrial size and the risk of ischemic stroke in an ethnically mixed population. Stroke. 1999;30:2019–2024. - PubMed

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