Havranek Stepan, Fiala Martin, Bulava Alan, Sknouril Libor, Dorda Miroslav, Bulkova Veronika, Fingrova Zdenka, Souckova Lucie, Palecek Tomas, Simek Jan, Linhart Ales, Wichterle Dan
2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
Department of Cardiology, Heart Centre, Hospital Podlesi, Trinec, Czech Republic.
PLoS One. 2016 Mar 29;11(3):e0152553. doi: 10.1371/journal.pone.0152553. eCollection 2016.
Left atrial (LA) enlargement is a predictor of worse outcome after catheter ablation for atrial fibrillation (AF). Widely used two-dimensional (2D)-echocardiography is inaccurate and underestimates real LA volume (LAV). We hypothesized that baseline clinical characteristics of patients can be used to adjust 2D-ECHO indices of LAV in order to minimize this disagreement.
The study enrolled 535 patients (59 ± 9 years; 67% males; 43% paroxysmal AF) who underwent catheter ablation for AF in three specialized centers. We investigated multivariately the relationship between 2D-echocardiographic indices of LA size, specifically LA diameter in M-mode in the parasternal long-axis view (LAD), LAV assessed by the prolate-ellipsoid method (LAVEllipsoid), LAV by the planimetric method (LAVPlanimetry), and LAV derived from 3D-electroanatomic mapping (LAVCARTO).
Cubed LAD of 106 ± 45 ml, LAVEllipsoid of 72 ± 24 ml and LAVPlanimetry of 88 ± 30 ml correlated only modestly (r = 0.60, 0.69, and 0.53, respectively) with LAVCARTO of 137 ± 46 ml, which was significantly underestimated with a bias (±1.96 standard deviation) of -31 (-111; +49) ml, -64 (-132; +2) ml, and -49 (-125; +27) ml, respectively; p < 0.0001 for their mutual difference. LA enlargement itself, age, gender, type of AF, and the presence of structural heart disease were independent confounders of measurement error of 2D-echocardiographic LAV.
Accuracy and precision of all 2D-echocardiographic LAV indices are poor. Their agreement with true LAV can be significantly improved by multivariate adjustment to clinical characteristics of patients.
左心房（LA）扩大是心房颤动（AF）导管消融术后预后较差的一个预测指标。广泛使用的二维（2D）超声心动图不准确，会低估实际左心房容积（LAV）。我们假设可以利用患者的基线临床特征来调整LAV的2D超声心动图指标，以尽量减少这种差异。
该研究纳入了535例在三个专业中心接受AF导管消融术的患者（年龄59±9岁；男性占67%；阵发性AF占43%）。我们多变量研究了LA大小的2D超声心动图指标之间的关系，具体包括胸骨旁长轴切面M型中的LA直径（LAD）、通过长椭球体法评估的LAV（LAVEllipsoid）、通过面积测量法得到的LAV（LAVPlanimetry）以及源自三维电解剖标测的LAV（LAVCARTO）。
LAD的立方值为106±45ml，LAVEllipsoid为72±24ml，LAVPlanimetry为88±30ml，与LAVCARTO的137±46ml仅呈中等程度相关（r分别为0.60、0.69和0.53），LAVCARTO被显著低估，偏差（±1.96标准差）分别为-31（-111；+49）ml、-64（-132；+2）ml和-49（-125；+27）ml；它们之间的差异p<0.0001。LA扩大本身、年龄、性别、AF类型以及结构性心脏病的存在是2D超声心动图LAV测量误差的独立混杂因素。
所有2D超声心动图LAV指标的准确性和精确性都很差。通过对患者临床特征进行多变量调整，它们与真实LAV的一致性可得到显著改善。
