[en] Aims: To obtain the normal ranges for echocardiographic measurements of left atrial (LA) function from a large group of healthy volunteers accounting for age and gender. Methods and results: A total of 371 (median age 45 years) healthy subjects were enrolled at 22 collaborating institutions collaborating in the Normal Reference Ranges for Echocardiography (NORRE) study of the European Association of Cardiovascular Imaging (EACVI). Left atrial data sets were analysed with a vendor-independent software (VIS) package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire data sets. The lowest expected values of LA function were 26.1%, 48.7%, and 41.4% for left atrial strain (LAS), 2D left atrial emptying fraction (LAEF), and 3D LAEF (reservoir function); 7.7%, 24.2%, and -0.53/s for LAS-active, LAEF-active, and LA strain rate during LA contraction (SRa) (pump function) and 12.0% and 21.6% for LAS-passive and LAEF-passive (conduit function). Left atrial reservoir and conduit function were decreased with age while pump function was increased. All indices of reservoir function and all LA strains had no difference in both gender and vendor. However, inter-vendor differences were observed in LA SRa despite the use of VIS. Conclusion: The NORRE study provides contemporary, applicable echocardiographic reference ranges for LA function. Our data highlight the importance of age-specific reference values for LA functions.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Sugimoto, Tadafumi
ROBINET, Sébastien ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Rythmologie & Pacemaker
DULGHERU, Raluca Elena ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Clinique des valvulopathies - Echocardiographies - Imagerie
Dernellis JM, Stefanadis CI, Zacharoulis AA, Toutouzas PK. Left atrial mechanical adaptation to long-standing hemodynamic loads based on pressure-volume relations. Am J Cardiol 1998;81:1138-43.
Guazzi M, Borlaug BA. Pulmonary hypertension due to left heart disease. Circulation 2012;126:975-90.
Kobayashi Y, Moneghetti KJ, Boralkar K, Amsallem M, Tuzovic M, Liang D et al. Challenging the complementarity of different metrics of left atrial function: insight from a cardiomyopathy-based study. Eur Heart J Cardiovasc Imaging 2017;18: 1153-62.
Debonnaire P, Leong DP, Witkowski TG, Al Amri I, Joyce E, Katsanos S et al. Left atrial function by two-dimensional speckle-Tracking echocardiography in patients with severe organic mitral regurgitation: Association with guidelinesbased surgical indication and postoperative (long-Term) survival. J Am Soc Echocardiogr 2013;26:1053-62.
Yasuda R, Murata M, Roberts R, Tokuda H, Minakata Y, Suzuki K et al. Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation. Eur Heart J Cardiovasc Imaging 2015;16:1008-14.
Santos AB, Kraigher-Krainer E, Gupta DK, Claggett B, Zile MR, Pieske B et al. Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail 2014;16:1096-103.
Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail 2015;8:295-303.
Sugimoto T, Bandera F, Generati G, Alfonzetti E, Bussadori C, Guazzi M. Left Atrial function dynamics during exercise in heart failure: pathophysiological implications on the right heart and exercise ventilation inefficiency. JACC Cardiovasc Imaging 2017;10:1253-64.
Russo C, Jin Z, Homma S, Rundek T, Elkind MSV, Sacco RL et al. LA Phasic volumes and reservoir function in the elderly by real-Time 3D echocardiography: normal values, prognostic significance, and clinical correlates. JACC Cardiovasc Imaging 2017;10:976-85.
Morris DA, Takeuchi M, Krisper M, Köhncke C, Bekfani T, Carstensen T et al. Normal values and clinical relevance of left atrial myocardial function analysed by speckle-Tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging 2015;16:364-72.
Pathan F, DElia N, Nolan MT, Marwick TH, Negishi K. Normal ranges of left atrial strain by speckle-Tracking echocardiography: A systematic review and metaanalysis. J Am Soc Echocardiogr 2017;30:59-70.
Miglioranza MH, Badano LP, Mihaila S, Peluso D, Cucchini U, Soriani N et al. Physiologic determinants of left atrial longitudinal strain: A two-dimensional speckle-Tracking and three-dimensional echocardiographic study in healthy volunteers. J Am Soc Echocardiogr 2016;29:1023-34.
Badano LP, Miglioranza MH, Mihaila S, Peluso D, Xhaxho J, Marra MP et al. Left atrial volumes and function by three-dimensional echocardiography: reference values, accuracy, reproducibility, and comparison with two-dimensional echocardiographic measurements. Circ Cardiovasc Imaging 2016;9:e004229.
Kou S, Caballero L, Dulgheru R, Voilliot D, De Sousa C, Kacharava G et al. Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Heart J Cardiovasc Imaging 2014;15:680-90.
Caballero L, Kou S, Dulgheru R, Gonjilashvili N, Athanassopoulos GD, Barone D et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging 2015;16: 1031-41.
Saura D, Dulgheru R, Caballero L, Bernard A, Kou S, Gonjilashvili N et al. Twodimensional transthoracic echocardiographic normal reference ranges for proximal aorta dimensions: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017;18:167-79.
Sugimoto T, Dulgheru R, Bernard A, Ilardi F, Contu L, Addetia K et al. Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017;18: 833-40.
Bernard A, Addetia K, Dulgheru R, Caballero L, Sugimoto T, Akhaladze N et al. 3D echocardiographic reference ranges for normal left ventricular volume and strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017;18:475-83.
Lancellotti P, Badano LP, Lang RM, Akhaladze N, Athanassopoulos GD, Barone D et al. Normal Reference Ranges for Echocardiography: rationale, study design, and methodology (NORRE Study). Eur Heart J Cardiovasc Imaging 2013; 14:303-8.
Cosyns B, Garbi M, Separovic J, Pasquet A, Lancellotti P; Education Committee of the European Association of Cardiovascular Imaging Association (EACVI). Update of the echocardiography core syllabus of the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2013;14:837-9.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233-70.
Kurt M, Wang J, Torre-Amione G, Nagueh SF. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2009;2:10-5.
Wu VC, Takeuchi M, Kuwaki H, Iwataki M, Nagata Y, Otani K et al. Prognostic value of LA volumes assessed by transthoracic 3D echocardiography: comparison with 2D echocardiography. JACC Cardiovasc Imaging 2013;6:1025-35.
Aune E, Baekkevar M, Roislien J, Rodevand O, Otterstad JE. Normal reference ranges for left and right atrial volume indexes and ejection fractions obtained with real-Time three-dimensional echocardiography. Eur J Echocardiogr 2009;10: 738-44.
Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM. LA strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging 2017;10: 735-43.
Khurram IM, Maqbool F, Berger RD, Marine JE, Spragg DD, Ashikaga H et al. Association between left atrial stiffness index and atrial fibrillation recurrence in patients undergoing left atrial ablation. Circ Arrhythm Electrophysiol 2016;9: e003163.
