Skip to main content
SpringerLink
Log in

Validation of Right Atrial Area as a Measure of Right Atrial Size and Normal Values of in Healthy Pediatric Population by Two-Dimensional Echocardiography

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Right atrial (RA) size is a prognostic indicator for heart failure and cardiovascular death in adults. Data regarding use of RA area (RAA) by two-dimensional echocardiography as a surrogate for RA size and allometric modeling to define appropriate indexing of the RAA are lacking. Our objective was to validate RAA as a reliable measure of RA size and to define normal reference values by transthoracic echocardiography (TTE) in a large population of healthy children and develop Z-scores using a validated allometric model for indexing RAA independent of age, sex, and body size. Agreement between RAA and volume by 2D, 3D TTE, and MRI was assessed. RAA not volume by 2D TTE is an excellent surrogate for RA size. RAA/BSA1 has an inverse correlation with BSA with a residual relationship to BSA (r = − 0.54, p < 0.0001). The allometric exponent (AE) derived for the entire cohort (0.85) also fails to eliminate the residual relationship. The entire cohort divided into two groups with a BSA cut-off of 1 m2 to provide the best-fit allometric model (r = 0). The AE by least square regression analysis for each group is 0.95 and 0.88 for BSA < 1 m2 and > 1 m2, respectively, and was validated against an independent sample. The mean indexed RAA ± SD for BSA ≤ 1 m2 and > 1 m2 is 9.7 ± 1.3 cm2 and 8.7 ± 1.3 cm2, respectively, and was used to derive Z-scores. RAA by 2D TTE is superior to 2D or 3D echocardiography-derived RA volume as a measure of RA size using CMR as the reference standard. RAA when indexed to BSA1, decreases as body size increases. The best-fit allometric modeling is used to create Z scores. RAA/BSA0.95 for BSA < 1 m2 and RAA/BSA0.88 for those with BSA > 1 m2 can be used to derive Z scores.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Kassen RE, Humpl T, Friedberg MK (2013) Prognostic significance of 2-dimensional, M-mode, and Doppler echo indices of right ventricular function in children with pulmonary arterial hypertension. Am J Cardiol 165:1024–1031

    Google Scholar 

  2. Sallach JA, Tang WHW, Borowski AG, Tong W, Porter T, Martin MG, Jasper SE, Shrestha K, Troughton RW, Klein AL (2009) Right atrial volume index in chronic systolic heart failure and prognosis. J Am Coll Cardiol Imaging 2:527–534

    Article  Google Scholar 

  3. Koestenberger M, Burmas A, Ravekes W, Avian A, Gamillscheg A, Grangl G, Grillitsch M, Hansmann G (2015) Echocardiographic reference values for right atrial size in children with and without atrial septal defects or pulmonary hypertension. Pediatr Cardiol 37(4):686–695

    Article  PubMed  Google Scholar 

  4. Muller H, Burri H, Lerch R (2008) Evaluation of right atrial size in patients with atrial arrhythmias: comparison of 2D versus real time 3D echocardiography. Echocardiography 25:617–623

    Article  PubMed  Google Scholar 

  5. Muller H, Noble S, Keller PF, Sigaud P, Gentil P, Lerch R et al (2008) Biatrial anatomical reverse remodelling after radiofrequency catheter ablation for atrial fibrillation: evidence from real-time three-dimensional echocardiography. Europace 10:1073–1078

    Article  PubMed  Google Scholar 

  6. Gaynor SL, Maniar HS, Bloch JB, Steendijk P, Moon MR (2005) Right atrial and ventricular adaptation to chronic right ventricular pressure overload. Circulation 112(suppl):I212–I218

    PubMed  Google Scholar 

  7. Maceira AM, Cosin-Sales J, Roughton M, Prasad SK, Pennell DJ (2013) Reference right atrial dimensions and volume estimation by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 15:29

    Article  PubMed  PubMed Central  Google Scholar 

  8. DePace NL, Ren JF, Kotler MN, Mintz GS, Kimbiris D, Kalman P (1983) Twodimensional echocardiographic determination of right atrial emptying volume: a noninvasive index in quantifying the degree of tricuspid regurgitation. Am J Cardiol 52:525–529

    Article  PubMed  CAS  Google Scholar 

  9. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713 (quiz 786)

    Article  PubMed  Google Scholar 

  10. Sarikouch S, Koerperich H, Boethig D, Peters B, Lotz J, Gutberlet M, Beerbaum P, Kuehne T (2011) Reference values for atrial size and function in children and young adults by cardiac MR: a study of the german competence network congenital heart defects. J Magn Reson Imaging 33:1028–1039. https://doi.org/10.1002/jmri.22521

    Article  PubMed  Google Scholar 

  11. Keller AM, Gopal AS, King DL (2000) Left and right atrial volume by freehand three-dimensional echocardiography: in vivo validation using magnetic resonance imaging. Eur J Echocardiogr 1:55–65. https://doi.org/10.1053/euje.2000.0010

    Article  PubMed  CAS  Google Scholar 

  12. Aune E, Baekkevar M, Roislien J, Rodevand O, Otterstad JE (2009) Normal reference ranges for left and right atrial volumen indexes and ejection fractions obtained with real-time three-dimensional echocardiography. Eur J Echocardiogr 10:738–744. https://doi.org/10.1093/ejechocard/jep054

    Article  PubMed  Google Scholar 

  13. Tsai-Goodman B, Geva T, Odegard KC, Sena LM, Powell AJ (2004) Clinical role, accuracy, and technical aspects of cardiovascular magnetic resonance imaging in infants. Am J Cardiol 94:69–74

    Article  PubMed  Google Scholar 

  14. Lang RM, Mor-Avi V, Sugeng L, Nieman PS, Sahn DJ (2006) Three-dimensional echocardiography: the benefits of the additional dimension. J Am Coll Cardiol 48:2053–2069

    Article  PubMed  Google Scholar 

  15. Sluysmans T, Colan SD (2005) Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol 99:445–457

    Article  PubMed  Google Scholar 

  16. Gutgesell HP, Rembold CM (1990) Growth of the human heart relative to body surface area. Am J Cardiol 65:662–668

    Article  PubMed  CAS  Google Scholar 

  17. Abbott RD, Gutgesell HP (1994) Effects of heteroscedasticity and skewness on prediction in regression: modeling growth of the human heart. Methods Enzymol 240:37–51

    Article  PubMed  CAS  Google Scholar 

  18. Bhatla P, Nielsen JC, Ko HH, Doucette J, Lytrivi ID, Srivastava S (2012) Normal values of left atrial volume in pediatric age group using a validated allometric model. Circ Cardiovasc Imaging 5:791–796

    Article  PubMed  Google Scholar 

  19. Lytrivi ID, Bhatla P, Ko HH et al (2011) Normal values for left ventricular volume in infants and young children by the echocardiographic subxiphoid five-sixth area by length (bullet) method. J Am Soc Echocardiogr 24:214–218

    Article  PubMed  Google Scholar 

  20. Wang Y, Gutman JM, Heilbron D, Wahr D, Schiller NB (1984) Atrial volume in a normal adult population by two-dimensional echocardiography. Chest 86:595–601

    Article  PubMed  CAS  Google Scholar 

  21. Ebtia M, Murphy D, Gin K, Lee PK, Jue J, Nair P, Mayo J, Barnes ME, Thompson DJ, Tsang TS (2015) Best method for right atrial volume assessment by two-dimensional echocardiography: validation with magnetic resonance imaging. Echocardiography 32(5):734–739

    Article  PubMed  Google Scholar 

  22. Whitlock M, Garg A, Gelow J, Jacobson T, Broberg C (2010) Comparison of left and right atrial volume by echocardiography versus cardiac magnetic resonance imaging using the area-length method. Am J Cardiol 106:1345–1350

    Article  PubMed  Google Scholar 

  23. Müller H, Burri H, Lerch R (2008) Evaluation of right atrial size in patients with atrial arrhythmias: comparison of 2D versus real time 3D echocardiography. Echocardiography 25(6):617–623

    Article  PubMed  Google Scholar 

  24. Kebed K, Kruse E, Addetia K, Ciszek B, Thykattil M, Guile B et al (2017) Atrial-focused views improve the accuracy of two-dimensional echocardiographic measurements of the left and right atrial volumes: a contribution to the increase in normal values in the guidelines update. Int J Cardiovasc Imaging 33:209–218

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge Erika Pedri RDCS and Rosalie Castaldo RDCS for echocardiographic measurements.

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA

    Hari Rajagopal, Santosh C. Uppu, Justin Weigand, Simon Lee, Ruchika Karnik, Helen Ko, Puneet Bhatla, James Nielsen, Ira Parness & Shubhika Srivastava

  2. Biostatistics, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, 10029, USA

    John Doucette

Authors
  1. Hari Rajagopal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Santosh C. Uppu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin Weigand
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Simon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ruchika Karnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Helen Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Puneet Bhatla
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. James Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. John Doucette
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ira Parness
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shubhika Srivastava
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shubhika Srivastava.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rajagopal, H., Uppu, S.C., Weigand, J. et al. Validation of Right Atrial Area as a Measure of Right Atrial Size and Normal Values of in Healthy Pediatric Population by Two-Dimensional Echocardiography. Pediatr Cardiol 39, 892–901 (2018). https://doi.org/10.1007/s00246-018-1838-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-018-1838-3

Keywords

Search

Navigation