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. 2023 Oct;64(10):951-956.

Left atrial measurement in lateral versus sternal recumbency in cats undergoing focused cardiac ultrasound examination

Priscilla Burnotte  1 , Kris Gommeren  1 , Christopher R Kennedy  1 , Søren R Boysen  1 , Anne-Christine Merveille  1
Affiliations

Left atrial measurement in lateral versus sternal recumbency in cats undergoing focused cardiac ultrasound examination

Priscilla Burnotte et al. Can Vet J. 2023 Oct.

Abstract
in English, French

Objective: To compare left atrial measurements carried out by an emergency and critical care (ECC) clinician on cats in lateral and sternal recumbency.

Animals and procedures: A prospective observational study was conducted between December 2019 and January 2021 at the university teaching hospital at University of Liège. One hundred and two hospitalized cats were enrolled. Focused cardiac ultrasound (FOCUS) was performed in right lateral and sternal recumbency by a single FOCUS-trained ECC resident. Standard right parasternal long- and short-axis views were recorded. After randomization of the cineloops, the same blinded resident measured maximal left atrial dimension (LAD) and the ratio of left atrial to aortic diameter (LA:Ao). Reproducibility was assessed using the Bland-Altman method.

Results: The LA:Ao and LAD measurements in lateral (LA:Ao median: 1.37, range: 1.02 to 3.22; LAD median: 13.25, range: 7.90 to 32.90) and sternal (LA:Ao median: 1.38, range: 1.06 to 3.22; LAD median: 13.00, range: 8.00 to 32.90) recumbency were not significantly different (bias: -0.003, CI -0.014, 0.007; and bias: -0.101, CI -0.231, 0.029, respectively).

Conclusions and clinical relevance: The FOCUS technique was successfully applied in sternal recumbency in almost all cats. The LAD and LA:Ao measured in sternal and lateral recumbency were not significantly different. Cardiac left atrial measurements obtained using FOCUS can be reliably assessed in sternal recumbency in hospitalized, stable cats.

Mesure de l’oreillette gauche en décubitus latéral versus sternal chez les chats soumis à une échographie cardiaque focalisée.

Objectif: Comparer les mesures de l’oreillette gauche effectuées par un clinicien des urgences et soins intensifs (ECC) sur des chats en décubitus latéral et sternal.

Animaux et procédures: Une étude observationnelle prospective a été menée entre décembre 2019 et janvier 2021 au CHU de l’Université de Liège. Cent deux chats hospitalisés ont été enrôlés. L’échographie cardiaque focalisée (FOCUS) a été réalisée en décubitus latéral droit et sternal par un seul résident ECC formé au FOCUS. Des vues parasternales droites grand et petit axe standards ont été enregistrées. Après randomisation des cineloops, le même résident en aveugle a mesuré la dimension auriculaire gauche maximale (LAD) et le rapport entre le diamètre de l’oreillette gauche et celui de l’aorte (LA:Ao). La reproductibilité a été évaluée à l’aide de la méthode de Bland-Altman.

Résultats: Les mesures LA:Ao et LAD en décubitus latéral (LA:Ao médian : 1,37, intervalle : 1,02 à 3,22; LAD médian : 13,25, intervalle : 7,90 à 32,90) et sternal (LA:Ao médian : 1,38, intervalle : 1,06 à 3,22; médiane LAD : 13,00, intervalle : 8,00 à 32,90) n’étaient pas significativement différents (biais : −0,003, IC −0,014, 0,007; et biais : −0,101, IC −0,231, 0,029, respectivement).

Conclusions et pertinence clinique: La technique FOCUS a été appliquée avec succès en décubitus sternal chez presque tous les chats. Le LAD et LA:Ao mesurés en décubitus sternal et latéral n’étaient pas significativement différents. Les mesures de l’oreillette cardiaque gauche obtenues à l’aide de FOCUS peuvent être évaluées de manière fiable en décubitus sternal chez les chats hospitalisés et stables.(Traduit par Dr Serge Messier).

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Figures

Figure 1
Figure 1
Right parasternal long-axis 4-chamber view. Measurement of the left atrial dimension (LAD) at the end of ventricular systole, when the left atrium is at its widest diameter.
Figure 2
Figure 2
Right parasternal short-axis (transaortic) view. Measurement of the left atrial to aortic diameter ratio (LA:Ao).
Figure 3
Figure 3
Scatterplot of LAD measured in lateral positioning versus LAD measured in sternal positioning, performed during a FOCUS examination. Results within the gray rectangular area of the graph correspond to LAD values above the previously reported LAD cutoff value of 16.5 mm (13). FOCUS — Focused cardiac ultrasound; LAD — Left atrial dimension; LR — Lateral recumbency; SR — Sternal recumbency.
Figure 4
Figure 4
Bland-Altman plot of reproducibility between the LAD measured in lateral and in sternal recumbency. The means for the 2 methods are presented on the X-axis, and the difference between the methods on the Y-axis. CI — Confidence interval; LAD — Left atrial dimension; LR — Lateral recumbency; SR — Sternal recumbency.
Figure 5
Figure 5
Scatterplot of LA:Ao measured in lateral positioning versus LA:Ao measured in sternal positioning, preformed during a FOCUS examination. Results within the gray rectangular area of the graph correspond to LA:Ao values above the previously reported LA:Ao cutoff value of 1.5 (13). FOCUS — Focused cardiac ultrasound; LA:Ao — Left atrial to aortic diameter ratio; LR — Lateral recumbency; SR — Sternal recumbency.
Figure 6
Figure 6
Bland-Altman plot of reproducibility between the LA:Ao measured in lateral and in sternal recumbency. The means for the 2 methods are presented on the X-axis, and the difference between the methods on the Y-axis. CI — Confidence interval; LA:Ao — Left atrial to aortic diameter ratio; LR — Lateral recumbency; SR — Sternal recumbency.
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