Clinical Investigation
Cardiac Chamber Volumes by Echocardiography
Comparison of Echocardiographic Single-Plane versus Biplane Method in the Assessment of Left Atrial Volume and Validation by Real Time Three-Dimensional Echocardiography

https://doi.org/10.1016/j.echo.2010.06.010Get rights and content

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 (κ = 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 (κ = 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.

Section snippets

Methods

The study was conducted at the Adult Cardiovascular Ultrasound Laboratories of Columbia University Medical Center. The study sample was derived from the National Institutes of Health–sponsored Cardiac Abnormalities and Brain Lesions (CABL) study, whose aim is to assess the relationship between cardiovascular subclinical disease and silent brain infarctions in a community-based cohort. Participants in CABL were drawn from the Northern Manhattan Study (NOMAS), an epidemiologic study carried out

Clinical Characteristics of the Study Sample

The study sample included 527 participants. The clinical characteristics are shown in Table 1. The mean age was 69.6 ± 9.7 years, and 61.9% were women. Hypertension was present in 68.5%, CAD in 5.9%, and atrial fibrillation in 2.1%. As expected, the large majority of the study participants were of Hispanic ethnic background (71.3%), with a minority of Caucasian (11.0%) and African American (14.2%) participants, reflecting the racial and ethnic composition of the community living in northern

Discussion

In our study, we compared echocardiographic single-plane LA volume determination with the biplane method. This is the first study to compare single-plane and biplane LA volume determination in a large population-based cohort and to explore the clinical reproducibility of the categorical agreement between the methods using current ASE cutoffs. The linear correlation between the biplane and the single-plane was excellent throughout the entire spectrum of LA volumes and was not affected by

Conclusions

This study shows that two-dimensional methods correlate well with 3D LA volume determination and that the single-plane method has a strong general correlation with the biplane method, suggesting its possible role as a simpler tool for measuring LA volume and its adequate accuracy when a biplane determination is not feasible. However, the frequent, albeit small, volume overestimation by the single-plane method results in a significant misclassification of patients when the ASE cutoffs are

Acknowledgments

We wish to thank Michele Alegre, RDCS, Rui Liu, MD, Janet DeRosa, MPH, and Rafi Cabral, MD, for their help in the collection of the data.

References (29)

Cited by (61)

  • Evaluation of Left Atrial Size and Function: Relevance for Clinical Practice

    2020, Journal of the American Society of Echocardiography
    Citation Excerpt :

    The recent multicenter Normal Reference Ranges for Echocardiography study, which included 734 healthy individuals, suggested that the normal limits for LAVmax may be even larger than the current 34 mL/m2 threshold (up to 42 mL/m2 using the area-length and 37 mL/m2 using the Simpson's method).22 Two-dimensional echocardiography LA volume correlates with LA volumes obtained using 3DE,32 CT,33 and cardiac magnetic resonance (CMR),34 with 2DE demonstrating a systematic underestimation of LA volumes.35-37 This is likely due to the foreshortening of the LA in the absence of dedicated acquisitions to maximize the LA long axis.

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This study was supported by grants R01 NS36286 (Marco R. Di Tullio, principal investigator) and NS29993 (Ralph L. Sacco, principal investigator) from the National Institute of Neurological Disorders and Stroke (Bethesda, MD).

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