Amita Singh1, Cristiane Carvalho Singulane2, Tatsuya Miyoshi3, Aldo D Prado4, Karima Addetia1, Michele Bellino5, Masao Daimon6, Pedro Gutierrez Fajardo7, Ravi R Kasliwal8, James N Kirkpatrick9, Mark J Monaghan10, Denisa Muraru11, Kofo O Ogunyankin12, Seung Woo Park13, Ricardo E Ronderos14, Anita Sadeghpour15, Gregory M Scalia16, Masaaki Takeuchi17, Wendy Tsang18, Edwin S Tucay19, Ana Clara Tude Rodrigues20, Amuthan Vivekanandan21, Yun Zhang22, Marcus Schreckenberg23, Michael Blankenhagen23, Markus Degel23, Niklas Hitschrich23, Victor Mor-Avi1, Federico M Asch3, Roberto M Lang24. 1. University of Chicago, Chicago, Illinois. 2. University of Chicago, Chicago, Illinois; São José do Rio Preto Medical School, São José do Rio Preto, Brazil. 3. MedStar Health Research Institute, Washington, District of Columbia. 4. Centro Privado de Cardiologia, Tucumán, Argentina. 5. University of Salerno, Salerno, Italy. 6. University of Tokyo, Tokyo, Japan. 7. Hospital Bernardette, Guadalajara, Mexico. 8. Medanta Medicity, Gurgaon, India. 9. University of Washington, Seattle, Washington. 10. King's College Hospital, London, United Kingdom. 11. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy. 12. First Cardiology Consultants Hospital Ikoyi, Lagos, Nigeria. 13. Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Korea. 14. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 15. Rajaie Cardiovascular Medical Center, Iran University of Medical Sciences, Tehran, Iran. 16. GenesisCare, Brisbane, Australia. 17. University of Occupational and Environmental Health, Kitakyushu, Japan. 18. Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. 19. Philippine Heart Center, Quezon City, Philippines. 20. Hospital Israelita Albert Einstein, São Paulo, Brazil. 21. Jeyalakshmi Heart Center, Madurai, India. 22. Qilu Hospital of Shandong University, Jinan, China. 23. TomTec Imaging Systems, Unterschleissheim, Germany. 24. University of Chicago, Chicago, Illinois. Electronic address: rlang@medicine.bsd.uchicago.edu.
Abstract
BACKGROUND: Left atrial (LA) evaluation includes volumetric and functional parameters with an abundance of diagnostic and prognostic implications. Solid normal reference ranges are compulsory for accurate interpretation in individual patients, but previous studies have yielded mixed conclusions regarding the effects of age, sex, and/or race. The present report from the World Alliance Societies of Echocardiography study focuses on two-dimensional (2D) and three-dimensional (3D) measures of LA structure and function, with subgroup analysis by age, sex, and race. METHODS: Transthoracic 2D and 3D echocardiographic images were obtained in 1,765 healthy individuals (901 men, 864 women) evenly distributed among age subgroups: 18 to 40 years (n = 745), 41 to 65 years (n = 618), and >65 years (n = 402); the racial distribution was 38.4% white, 39.9% Asian, and 9.7% black. Images were analyzed using dedicated LA analysis software to measure LA volumes and phasic function from 3D volume and 2D strain curves. RESULTS: Three-dimensional maximum and minimum LA volumes adjusted for body surface area were nearly identical for men and women, but women demonstrated higher 3D total and passive emptying fractions (EFs). Two-dimensional reservoir strain was similar for both sexes. Age was associated with an incremental rise in LA volumes alongside characteristic shifts in functional indices. Total 2D EF and reservoir and conduit strain varied inversely with age, counteracted by higher booster strain, with a greater magnitude of effect in women. Active 3D EF was significantly higher, while total and passive EFs decreased with age. Interracial differences were noted in LA volumes, without substantial differences in functional indices. CONCLUSION: Although similar normal values for LA volumes and strain can be applied to both sexes, meaningful differences in LA size occur with aging. Indices of function also shift with age, with a compensatory rise in booster function, which may serve to counteract observed lower total and passive EFs. Defining age-associated normal values may help differentiate age-associated "healthy" LA aging from pathologic processes.
BACKGROUND: Left atrial (LA) evaluation includes volumetric and functional parameters with an abundance of diagnostic and prognostic implications. Solid normal reference ranges are compulsory for accurate interpretation in individual patients, but previous studies have yielded mixed conclusions regarding the effects of age, sex, and/or race. The present report from the World Alliance Societies of Echocardiography study focuses on two-dimensional (2D) and three-dimensional (3D) measures of LA structure and function, with subgroup analysis by age, sex, and race. METHODS: Transthoracic 2D and 3D echocardiographic images were obtained in 1,765 healthy individuals (901 men, 864 women) evenly distributed among age subgroups: 18 to 40 years (n = 745), 41 to 65 years (n = 618), and >65 years (n = 402); the racial distribution was 38.4% white, 39.9% Asian, and 9.7% black. Images were analyzed using dedicated LA analysis software to measure LA volumes and phasic function from 3D volume and 2D strain curves. RESULTS: Three-dimensional maximum and minimum LA volumes adjusted for body surface area were nearly identical for men and women, but women demonstrated higher 3D total and passive emptying fractions (EFs). Two-dimensional reservoir strain was similar for both sexes. Age was associated with an incremental rise in LA volumes alongside characteristic shifts in functional indices. Total 2D EF and reservoir and conduit strain varied inversely with age, counteracted by higher booster strain, with a greater magnitude of effect in women. Active 3D EF was significantly higher, while total and passive EFs decreased with age. Interracial differences were noted in LA volumes, without substantial differences in functional indices. CONCLUSION: Although similar normal values for LA volumes and strain can be applied to both sexes, meaningful differences in LA size occur with aging. Indices of function also shift with age, with a compensatory rise in booster function, which may serve to counteract observed lower total and passive EFs. Defining age-associated normal values may help differentiate age-associated "healthy" LA aging from pathologic processes.
Authors: Francesco Bandera; Anita Mollo; Matteo Frigelli; Giulia Guglielmi; Nicoletta Ventrella; Maria Concetta Pastore; Matteo Cameli; Marco Guazzi Journal: Front Cardiovasc Med Date: 2022-01-13
Authors: Charlotte Kulka; Roberto Lorbeer; Esther Askani; Elias Kellner; Marco Reisert; Ricarda von Krüchten; Susanne Rospleszcz; Dunja Hasic; Annette Peters; Fabian Bamberg; Christopher L Schlett Journal: Tomography Date: 2022-08-31