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Back to 2014 Annual Meeting Abstracts

Left Atrial Mid Cross Sectional Area And Left Atrial Shape Index: Novel Echocardiographic Measures Which Mechanistically Reflect Risk Of Atrial Fibrillation And Stroke
Timothy Tan, Maria C. Nunes, Mark Handschumacher, Judy Hung.
Massachusetts General Hospital, Boston, MA, USA.

OBJECTIVE: Left atrial (LA) remodelling is a significant risk factor for atrial fibrillation (AF) and stroke particularly in valvular disease such as rheumatic mitral stenosis (MS). Typically, LA remodelling results in increase in size and change in morphology of the LA. Our aim was to develop novel and simple echocardiographic measures for LA size and shape reflective of LA flow dynamics that can be applied in a clinical setting to improve risk stratification of AF and stroke.
METHODS: Conventional and novel 2D echo measures of LA size were examined in a prospective cohort of 1275 ischemic stroke patients (IS) in the context of etiology of stroke and AF. Specifically, mid LA cross sectional area (LA CSA) which reflects both LA size and shape, was calculated using the formula π/4 x largest measured LA diameter x smallest measured LA diameter at end-systole where mid LA diameter was measured in the parasternal long axis, 4 chamber and 2 chamber views. LA shape and its association with embolic stroke was then examined in a separate cohort of 212 patients with rheumatic MS where LA shape was expressed as ratio of measured LA end-systolic volume to hypothetical sphere volume (4/3π r3 where r=radius obtained from 3D LA CSA).
RESULTS: In the cohort of IS patients, increased LA CSA (8.6±2.3 vs 6.4±1.8 cm2/m2; p <0.001) was associated with cardioembolic strokes. Patients with AF also had increased LA CSA (8.7±2.5 vs 6.3±1.7 cm2/m2; p <0.001) compared to sinus rhythm which was significant after adjustment for the effects of age, gender, hypertension, E/E' and LVEF (OR 1.6; 95% CI 1.46 to 1.74; p<0.001). Of the 212 patients with MS, 41 had a stroke. In multivariate analysis, LA 3D emptying fraction (adjusted OR 0.95; 95% CI 0.91 to 0.98; p=0.012) and LA shape index (OR 0.69; 95% CI 0.57 to 0.85; p<0.001) provided incremental predictive value for stroke beyond age and AF.
CONCLUSIONS: LA CSA and LA shape index are novel echocardiographic measures which mechanistically reflect risk of AF and stroke, and may potentially be useful in the clinical setting for risk stratification of AF and stroke

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