|Year : 2012 | Volume
| Issue : 3 | Page : 97-99
Echocardiographic assessment of left atrial volume index in elderly patients with left ventricle anterior myocardial infarction
Monika Maheshwari, CP Tanwar, SK Kaushik
Department of Cardiology, J.L.N. Medical College, Ajmer, Rajasthan, India
|Date of Web Publication||9-Oct-2012|
Navin Niwas, 434/10, Bapu Nagar, Ajmer-3050001, Rajasthan
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Enlarged left atrium predicts outcomes in patients with heart failure, atrial fibrillation and stroke. Left atrial volume especially when corrected for body size, is a more accurate representation of true LA size.
Aims and Objectives: To study left atrial volume index in elderly patients with left ventricle anterior infarction and correlate LAVi with left ventricle ejection fraction and transmitral Doppler flow.
Materials and Methods: Control group consisted of 25 healthy elderly subjects Study group consisted of age and sex matched patients with LV anterior infarction with history of characteristic ischaemic chest pain. Patients with valve lesions, large shunts and rythum disturbances were excluded. On transthoracic echocardiography biplane method of disks was used to calculate LA volume. LAVi was calculated by dividing LA volume by body surface area of subjects.
Observation and Results: LAVi was significantly raised in elderly patients who suffered from AMI (P<0.005). We also found significant negative correlation of LAVi with LVEF, E wave peak velocity and deacceleration time.
Conclusion: Patients with advanced left venticular systolic and diastolic dysfunction had a significantly larger LAVi than healthy subjects. LAVi is useful for risk stratification and for guiding therapy in such patients.
Keywords: Left atrium, left atrium volume index, left ventricle ejection fraction
|How to cite this article:|
Maheshwari M, Tanwar C P, Kaushik S K. Echocardiographic assessment of left atrial volume index in elderly patients with left ventricle anterior myocardial infarction. Heart Views 2012;13:97-9
|How to cite this URL:|
Maheshwari M, Tanwar C P, Kaushik S K. Echocardiographic assessment of left atrial volume index in elderly patients with left ventricle anterior myocardial infarction. Heart Views [serial online] 2012 [cited 2018 May 23];13:97-9. Available from: http://www.heartviews.org/text.asp?2012/13/3/97/102149
| Introduction|| |
Recent evidence highlight the importance of enlarged left atrium (LA) as a barometer of diastolic burden and a good predictor of cardiovascular outcomes - including heart failure (HF), atrial fibrillation, stroke, and mortality.  It is considered a marker of chronically increased left atrial pressure and/or volume. LA volume has been compared to the "glycated hemoglobin of diabetes mellitus",  as it is a reflection of a long-standing hemodynamic condition. Because left atrial size can be measured noninvasively by echocardiography, measurement of LA size is part of the standard echocardiographic examination.
The traditional method of assessing maximal end-systolic anteroposterior dimension of LA from the parasternal long-axis view in M-mode is simple and convenient but its accuracy may be limited by the anatomical confinement afforded by the spine and sternum and the resulting asymetrical or pillow-shaped enlargement of the left atrium.  Hence, measurement of a single LA diameter may underestimate actual LA size. For these reasons, multiple linear dimensions or measurement of left atrial volume (LAV) especially when corrected for body size (LAVi) is a more accurate representation of true LA size. 
| Aims and Objective|| |
Our aim in the present study was to study left atrial volume index (LAVi) in elderly patients with left ventricle anterior infarction and to correlate LAVi with left ventricle ejection fraction (LVEF) and transmitral Doppler flow.
| Materials and Methods|| |
The present study was conducted at the Department of Cardiology of Jawahar Lal Nehru Medical College and Associate Group of Hospitals, Ajmer, India.
Grouping of subjects
- Control group n = 25: This group consisted of 25 elderly subjects (>70 years) without history of ischemic heart disease, systemic hypertension, and with normal findings in rest and exercise ECG and echocardiography.
- Study group n = 50: This group consisted of age- and sex-matched patients with left ventricle (LV) anterior infarction with history of characteristic ischemic chest pain (>30 min), ST segment elevation >2 mm in anterior leads I, aVL, V 1 -V 6 , and positive serum cardiac markers (CPK-MB, Troponin I).
Design of study
- Significant valve lesions (mitral stenosis or greater than moderate mitral regurgitation)
- Large shunts
- Atrial flutter and fibrillation
- Bundle branch block
- Poor acoustic window
The following detailed analysis were done for all subjects.
Complete and thorough analysis of all anterior leads in rest and exercise ECG was done.
Transthoracic 2D echocardiography
A transthoracic 2D echocardiographic examination was performed with patients in the left lateral decubitus position. The equipment used was SIEMENS transthoracic echocardiographic machine G-5 and CV-70 with 3.5 MHz transducer. With the use of apical 4-chamber view Simpson's LVEF was calculated as percentage of changes in LV chamber volumes between diastole and systole using formula EDV- ESV / EDV × 100. LA volume was measured from standard apical 4-chamber views at end-systole just before mitral valve opening. LA borders were traced using planimetry in control and study subjects [Figure 1] and [Figure 2]. The borders consisted of the walls of the left atrium excluding pulmonary veins and left atrial appendage. The biplane method of disks was used to calculate LA volume. LAVi was calculated by dividing LA volume by body surface area of subjects. Peak transmitral flow E and A wave velocity, E wave deceleration time, were measured from the apical 4-chamber view.
|Figure 1: Trans thoracic echocardiogram (Apical 4 chamber view) showing assessment of LAV in normal healthy subjects|
Click here to view
|Figure 2: Trans thoracic echocardiogram (Apical 4 chamber view) showing assessment of LAV in study group subjects|
Click here to view
Data were expressed as mean ± SD. Comparison of all variables in both groups was done by using "unpaired Student's t-test". Degree of freedom was calculated and P value was obtained. The results of P value were interpreted as follows: P > 0.05 - Not significant,P < 0.025 - Significant, P < 0.01 - Very significant, and P < 0.005 - Highly significant.
[Table 1] shows the basal clinical characteristics of the two groups. There was no significant difference in age, gender, BMI, pulse rate, and blood pressure between the two groups (P > 0.05).
|Table 1: Basal clinical characteristics of study and control group subjects|
Click here to view
[Table 2] shows systolic dysfunction (LVEF- 45 ± 10% vs 76 ± 9%) and stage 1 diastolic dysfunction in patients with left ventricle anterior myocardial infarction (LVAMI) as compared with healthy control group. LAVi was significantly raised in elderly patients who suffered from anterior myocardial infarction (AMI) (26.7 ± 2.1 vs 10.8 ± 2.9) (P < 0.005). [Table 3] shows significant negative correlation of LAVi with LVEF, E wave peak velocity, and deceleration time.
|Table 2: Values of echocardiographic LV systolic and diastolic function parameters in study and control group subjects|
Click here to view
| Discussion|| |
LAVi <28 ml/m 2 at rest predicts normal stress echocardiogram  and LAVi > 32 ml/m 2 predicts mortality in patients with acute myocardial infarction (MI).  LAVi (>50 ml/m 2 ) predicts HF hospitalization and mortality with similar statistical power as LVEF (< 45%) in ambulatory adults with coronary artery disease.  Increased LA volume is also a predictor of stroke and death. An indexed LA volume of ≥32 ml/m 2 is associated with an increased risk of stroke independent of age and other clinical risk factors for cerebrovascular disease.  LA volume is intimately related to LV mass/hypertrophy, systolic, and diastolic dysfunction.  The only determinant of LA size is body surface area. LA size in a healthy person is independent of age. Indeed, increase in LA size is a reflection of pathophysiologic abnormalities that accompany advancing age rather than a consequence of chronologic aging. 
| Conclusion|| |
Patients with advanced left ventricular systolic and diastolic dysfunction had a significantly larger LAVi than healthy subjects.
| References|| |
|1.||Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, et al. Left atrial size physiologic determinants and clinical applications. J Am Coll Cardiol 2006;47:2357-63. |
|2.||Paul B. Left atrial volume - A New Index in Echocardiography. JAPI 2009;57:463-7. |
|3.||Kedia G, Habibzadeh MR, Kudithipudi V, Molls F, Sorrell VL. Using traditional measurement of left atrial diameter to predict the left atrial volume index. Echocardiography 2008;25:36-9. |
|4.||Lester SJ, Ryan EW, Schiller NB, Foster E. Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol 1999;84:829-32. |
|5.||Alsaileek AA, Osranek M, Fatema K, McCully RB, Tsang TS, Seward JB. Predictive value of normal left atrial volume in stress echocardiography. J Am Coll Cardiol 2006;47:1024-8. |
|6.||Moller JE, Hillis GS, Oh JK, Seward JB, Reeder GS, Wright RS, et al. Left atrial volume: A powerful predictor of survival after acute myocardial infarction. Circulation 2003;107:2207-12. |
|7.||Ristow B, Ali S, Whooley MA, Schiller NB. Usefulness of left atrial volume index to predict heart failure hospitalization and mortality in ambulatory patients with coronary heart disease and comparison to left ventricular ejection fraction (from the heart and soul study). Am J Cardiol 2008;102:70-6. |
|8.||Fatema K, Bailey KR, Petty GW, Meissner I, Osranek M, Alsaileek AA, et al. Increased left atrial volume index: Potent biomarker for First ever ischaemic stroke. Mayo Clin Proc 2008;83:1107-15. |
|9.||Thomas L, Levett K, Boyd A, Leung DY, Schiller NB, Ross DL. Changes in regional left atrial function with aging: Evaluation by doppler tissue imaging. Eur J Echocardiography 2003;4:36-42. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]