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The Left Atrio-Vertebral Ratio: a new simple means for assessing left atrial enlargement on Computed Tomography

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Abstract

Objective

The purpose of this study is to describe a new method to quickly estimate left atrial enlargement (LAE) on Computed Tomography.

Methods

Left atrial (LA) volume was assessed with a 3D-threshold Hounsfield unit detection technique, including left atrial appendage and excluding pulmonary venous confluence, in 201 patients with ECG-gated 128-slice dual-source CT and indexed to body surface area. LA and vertebral axial diameter and area were measured at the bottom level of the right inferior pulmonary vein ostium. Ratio of LA diameter and surface on vertebra (LAVD and LAVA) were compared to LA volume. In accordance with the literature, a cutoff value of 78 ml/m2 was chosen for maximal normal LA volume.

Results

18% of LA was enlarged. The best cutoff values for LAE assessment were 2.5 for LAVD (AUC: 0.65; 95% CI: 0.58-0.73; sensitivity: 57%; specificity: 71%), and 3 for LAVA (AUC: 0.78; 95% CI: 0.72-0.84; sensitivity: 67%; specificity: 79%), with higher accuracy for LAVA (P=0.015). Inter-observer and intra-observer variability were either good or excellent for LAVD and LAVA (respective intraclass coefficients: 0.792 and 0.910; 0.912 and 0.937).

Conclusion

A left atrium area superior to three times the vertebral area indicates LAE with high specificity.

Key points

• Left atrial enlargement is a frequent condition associated with poor cardiac outcome.

• Left atrial enlargement is highly time-consuming to diagnose on CT.

• The left atrio-vertebral ratio quickly assesses left atrial enlargement.

• A left atrial area > three times vertebral area is highly specific.

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Abbreviations

iLAESV :

Indexed to BSA left atrial end-systolic volume

iLAMDV :

Indexed to BSA left atrial mid-diastolic volume

LA:

Left atrium, left atrial

LAA:

Left atrial area

LAD:

Left atrial diameter

LAE:

Left atrial enlargement

LAESV :

Left atrial end-systolic volume

LAMDV :

Left atrial mid-diastolic volume

LAVA:

Left atrio-vertebral area ratio

LAVD:

Left atrio-vertebral diameter ratio

LAVR:

Left atrio-vertebral ratio

VA:

Vertebral body area

VD:

Vertebral body diameter

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Acknowledgements

We gratefully acknowledge the other investigators and the staff for their valuable contributions. We also wish to thank Jeffrey Arsham for reviewing our original English-language manuscript.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France

    Marie Montillet & Jean-Pierre Tasu

  2. Hôpital Princesse Grace, 1 avenue Pasteur, 98012, Monaco, France

    Marie Baqué-Juston, Sandra Bertrand, Frédéric Berthier, Naïma Zarqane & Philippe Brunner

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  1. Marie Montillet
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Correspondence to Marie Montillet.

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Guarantor

The scientific guarantor of this publication is Dr Baqué-Juston.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr Frédéric Berthier kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was not required because of the retrospective design of the study.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Montillet, M., Baqué-Juston, M., Tasu, JP. et al. The Left Atrio-Vertebral Ratio: a new simple means for assessing left atrial enlargement on Computed Tomography. Eur Radiol 28, 1310–1317 (2018). https://doi.org/10.1007/s00330-017-5041-3

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  • DOI: https://doi.org/10.1007/s00330-017-5041-3

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