Prognostic Value of Left Atrial Size and Functional Indices Measured by 3-Dimensional Speckle-Tracking Analysis

• Published in: Circulation Journal Vol. 83; no. 4; pp. 801 - 808
• Main Authors: Tsujiuchi, Miki, Yamauchi, Takenori, Ebato, Mio, Maezawa, Hideyuki, Nogi, Ayaka, Ikeda, Naoko, Mizukami, Takuya, Nagumo, Sakura, Iso, Yoshitaka, Nakadate, Toshio, Kokaze, Akatsuki, Suzuki, Hiroshi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.03.2019
• Subjects: 3D speckle-tracking echocardiography; Aged; Aged, 80 and over; Atrial Function, Left; Echocardiography - methods; Echocardiography, Three-Dimensional - methods; Female; Heart Atria - pathology; Heart Diseases - diagnosis; Heart Diseases - diagnostic imaging; Heart Diseases - physiopathology; Humans; Left atrial function; Left atrial size; Male; Middle Aged; Prognosis; Prognostic value; Retrospective Studies; ROC Curve; Stroke Volume; Prognostic value; 3D speckle-tracking echocardiography; Left atrial function; Left atrial size
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-18-0554

Background: The prognostic value of indices for left atrial volumes (LAV) and reservoir function measured by 3D speckle-tracking analysis (3DSTA) has not been determined. Methods and Results: LA maximal and minimal volume indices (LAVImax, LAVImin), and LA emptying fraction (LAEmpF) were measured via 2D echocardiography (2DE) and 3DSTA in 514 patients (62% male, mean age: 66±15 years) with various cardiovascular diseases. Two cutoff values using normal±2SD (cutoff criterion 1) and receiver-operating characteristic analysis (cutoff criterion 2) were evaluated. During a mean follow-up of 720±383 days, MACE (cardiac death, nonfatal myocardial infarction, stroke and admission for heart failure) occurred in 98 patients. Kaplan-Meier survival analysis showed both cutoff criteria measured by 2DE and 3DSTA had significant predictive power for MACE (P<0.001). For cutoff criterion 1, 3DSTA measurements yielded higher hazard ratios than 2DE by Cox proportional hazard model. Cutoff criterion 2 using 3DSTA had higher average treatment effect values than 2DE by matching propensity scores on the outcome. Further, a regression model that included clinical variables, left ventricular ejection fraction and cutoff criterion 2 using 3DSTA-derived LAEmpF had significantly higher prognostic power than 2DE. Conclusions: LA indices measured by 3DSTA had greater prognostic power for future MACE than 2DE. In particular, 3DSTA-derived LAEmpF has the potential to be a valuable prognostic tool in clinical settings.