Batal Omar, Brumberg Howard, Teuteberg Jeffrey J, Katz William E
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Echocardiography. 2014 Mar;31(3):274-8. doi: 10.1111/echo.12349. Epub 2013 Sep 6.
The left atrium (LA) in the transplanted heart (TH) is a surgically created chamber from variable portions of donor and recipient LA. The American Society of Echocardiography (ASE) recommends measuring LA size in native hearts using biplane LA volume index (LAVI) as a more accurate measurement than LA anterior-posterior diameter (LA-APD). We hypothesized that LA-APD underestimates LA size when compared with LAVI in the TH.
Patients with a TH from 1/05 to 1/10 who had a transthoracic echocardiogram within 24 months of transplant were studied. Patients were excluded if they had an ejection fraction <50%, left ventricular hypertrophy, >mild aortic or mitral regurgitation, or poor image quality. Echocardiograms were analyzed for LA-APD and LAVI. LA size was classified as normal, mild, moderate, or severely enlarged based on age and sex specific cutoffs per the ASE.
Of 297 patients evaluated, 160 met inclusion criteria. Mean age was 57 ± 13 years and 79% were males. Mean LA-APD and LAVI were 4.3 ± 0.6 cm and 36 ± 14 mL/m(2), respectively. LAVI correlated with LA-APD (r = 0.43, R(2) = 0.18, P < 0.0001). By LA-APD measurement, 20 (13%) LA were classified as having moderate or severe LA enlargement versus 80 (50%) by LAVI, P = 0.001. LA size was underclassified by ≥ 2 classes in 44 (28%) by LA-APD versus LAVI.
In the setting of cardiac transplant, the LA size classified by LA-APD is commonly less than that classified by LAVI.
移植心脏（TH）中的左心房（LA）是由供体和受体LA的不同部分通过手术创建的腔室。美国超声心动图学会（ASE）建议在测量自然心脏的LA大小时，使用双平面LA容积指数（LAVI），因为它比LA前后径（LA-APD）更准确。我们假设在TH中，与LAVI相比，LA-APD会低估LA大小。
研究了2005年1月至2010年1月期间接受TH且在移植后24个月内进行经胸超声心动图检查的患者。如果患者射血分数<50%、左心室肥厚、主动脉或二尖瓣反流>轻度或图像质量差，则将其排除。对超声心动图进行LA-APD和LAVI分析。根据ASE的年龄和性别特异性临界值，将LA大小分为正常、轻度、中度或重度扩大。
在评估的297例患者中，160例符合纳入标准。平均年龄为57±13岁，79%为男性。平均LA-APD和LAVI分别为4.3±0.6 cm和36±14 mL/m²。LAVI与LA-APD相关（r = 0.43，R² = 0.18，P < 0.0001）。通过LA-APD测量，20例（13%）LA被分类为中度或重度LA扩大，而通过LAVI测量为80例（50%），P = 0.001。与LAVI相比，44例（28%）通过LA-APD测量的LA大小被低分类≥2级。
在心脏移植的情况下，通过LA-APD分类的LA大小通常小于通过LAVI分类的LA大小。
