在巴西无既往心脏病且超声心动图显示心脏正常的人群中，通过体表面积和身高对左心房容积进行指数化分析。肥胖和超重患者的情况
Indexing of Left Atrial Volume by Body Surface Area and Height in a Brazilian Population without Previous Heart Disease and with a Normal Heart on Echocardiography. Behavior in Obese and Overweight Patients.
作者信息
Nassri Camara Edmundo J, do Prado Valladares Flávia R, Key Ng Kin, Santana Paloma Fonseca, Kawaoka Jun Ramos, Campos Thais Harada, Santana Marcus Ribeiro de O, Cunha Alex Costa, Sampaio Danilo Sousa, Santana Gustavo Pinheiro, Brito Luis Gustavo S, Dourado Narjara de O Cardoso, Nascimento Saulo Jende, Lira Alice Povoa A L, do Nascimento Naily N, Dos Santos Romeu Pacheco F, Rocha Sérgio Rodrigo F, Machado Thaise Gordiano
机构信息
Federal University of Bahia, Brazil.
Hospital Ana Nery, Salvador - Bahia, Brasil.
出版信息
Cardiol Cardiovasc Med. 2023;7(1):25-31. doi: 10.26502/fccm.92920304. Epub 2023 Jan 29.
BACKGROUND
Left atrial (LA) volume indexing for body surface area (BSA) may underestimate LA size in obese and overweight people. Since LA volume is a risk marker for some cardiovascular events, it is suggested that indexing for height would be an alternative more appropriate method. The aims of this study were to find normal and the best cutoff values for LA volume indexed for height in our population.
METHODS
Echocardiograms from 2018 to 2021 were reviewed and patients without known cardiac disease and completely normal echocardiograms that had the left atrial volume (LAvol) measured by biplane Simpson's method were included. LAvol was indexed by BSA (ml/m), by height (LAvol/m), by height raised to exponent 2.7 (ml/ m) and by height squared (ml/h).
RESULTS
A total of 545 patients, 50.5 ± 13.4 y., 335 females (61,5%) were analyzed. There were 145 normal weight (26.6%), 215 overweight (39.4%), 154 obese (28.3%) and 31 low weight (5.7%) patients. To establish normal values we included only the normal weight group and considered normal values from 2SD below to 2SD above the mean. Mean and normal values were: LAvol/h 26.0 ±4.5, 17 - 35 ml/m, LAvol/ht 16 ± 2.8, 10.4 - 21.6 ml/ ht and LAvol/ht 11.4 ± 2.2, 7.0 - 15.8 ml/m. The normal LAvol/ht differed between male and female (11.4 ± 2.4 and 12.8 ± 2.6, p < 0.001). LA diameter, LAvol, LAvol/h, LAvol/h and LAvol/ht increased progressively from low-weight, normal weight, overweight and obese patients (p< 0.0001), but not LAvol/BSA. When indexing LAvol for height, for height and for height 20.8%, 22.7% and 21.4% of the obese patients, respectively, were reclassified as enlarged LA, and 7.4%, 8.8% and 8.4% of the overweight patients as well. Using ROC curve analysis, LAvol/h had the highest AUC ant the best predictive value to identify LA enlargement and LAvol/BSA the worst one.
CONCLUSIONS
Normal values for LAvol indexed for height by three different methods are described in normal individuals. We reinforce that LAvol indexation for BSA underestimates LA size in obese and overweight patients and in these groups, specially, indexing for height is probably the best method to evaluate LAvol.
背景
根据体表面积（BSA）对左心房（LA）容积进行指数化计算，可能会低估肥胖和超重人群的左心房大小。由于左心房容积是一些心血管事件的风险标志物，因此有人提出根据身高进行指数化计算可能是一种更合适的替代方法。本研究的目的是找出我们人群中根据身高对左心房容积进行指数化计算的正常和最佳临界值。
方法
回顾了2018年至2021年的超声心动图，纳入了无已知心脏病且超声心动图完全正常、采用双平面辛普森法测量左心房容积（LAvol）的患者。LAvol分别根据BSA（ml/m²）、身高（LAvol/m）、身高的2.7次幂（ml/m².⁷）和身高平方（ml/m²）进行指数化计算。
结果
共分析了545例患者，年龄50.5±13.4岁，其中335例为女性（61.5%）。有145例体重正常（26.6%）、215例超重（39.4%）、154例肥胖（28.3%）和31例体重过轻（5.7%）患者。为确定正常值，我们仅纳入了体重正常组，并将均值上下2个标准差范围内的值视为正常值。均值和正常值分别为：LAvol/m² 26.0±4.5，17 - 35 ml/m²；LAvol/m 16±2.8，10.4 - 21.6 ml/m；LAvol/m².⁷ 11.4±2.2，7.0 - 15.8 ml/m²。正常的LAvol/m在男性和女性之间存在差异（11.4±2.4和12.8±2.6，p<0.001）。左心房直径、LAvol、LAvol/m、LAvol/m².⁷和LAvol/m²从体重过轻、体重正常、超重到肥胖患者逐渐增加（p<0.0001），但LAvol/BSA并非如此。当根据身高、身高的2.7次幂和身高平方对LAvol进行指数化计算时，分别有20.8%、22.7%和21.4%的肥胖患者被重新分类为左心房扩大，超重患者中这一比例分别为7.4%、8.8%和8.4%。使用ROC曲线分析，LAvol/m对识别左心房扩大具有最高的AUC和最佳预测价值，而LAvol/BSA的预测价值最差。
结论
描述了正常个体中通过三种不同方法根据身高对LAvol进行指数化计算的正常值。我们强调，根据BSA对LAvol进行指数化计算会低估肥胖和超重患者的左心房大小，在这些人群中，特别是根据身高进行指数化计算可能是评估LAvol的最佳方法。
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