Multivariate Analysis of Correspondence between Left Atrial Volumes Assessed by Echocardiography and 3-Dimensional Electroanatomic Mapping in Patients with Atrial Fibrillation
Abstract
Background 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. Methods 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 (LAV(Ellipsoid)), LAV by the planimetric method (LAV(Planimetry)), and LAV derived from 3D-electroanatomic mapping (LAV(CARTO)). Results Cubed LAD of 106 +/- 45 ml, LAV(Ellipsoid) of 72 +/- 24 ml and LAV(Planimetry) of 88 +/- 30 ml correlated only modestly (r = 0.60, 0.69, and 0.53, respectively) with LAV(CARTO) 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. Conclusion 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.