Skip to main content
Erschienen in: Pediatric Cardiology 5/2018

09.03.2018 | Original Article

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

verfasst von: Hari Rajagopal, Santosh C. Uppu, Justin Weigand, Simon Lee, Ruchika Karnik, Helen Ko, Puneet Bhatla, James Nielsen, John Doucette, Ira Parness, Shubhika Srivastava

Erschienen in: Pediatric Cardiology | Ausgabe 5/2018

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat 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 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
2.
Zurück zum Zitat 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 2:527–534CrossRef 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 2:527–534CrossRef
3.
Zurück zum Zitat 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):686–695CrossRefPubMed 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):686–695CrossRefPubMed
4.
Zurück zum Zitat 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 25:617–623CrossRefPubMed 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 25:617–623CrossRefPubMed
5.
Zurück zum Zitat 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 10:1073–1078CrossRefPubMed 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 10:1073–1078CrossRefPubMed
6.
Zurück zum Zitat 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–I218PubMed 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–I218PubMed
7.
Zurück zum Zitat 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 15:29CrossRefPubMedPubMedCentral 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 15:29CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat 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 52:525–529CrossRefPubMed 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 52:525–529CrossRefPubMed
9.
Zurück zum Zitat 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)CrossRefPubMed 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)CrossRefPubMed
10.
Zurück zum Zitat 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 CrossRefPubMed 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 CrossRefPubMed
13.
Zurück zum Zitat 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 94:69–74CrossRefPubMed 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 94:69–74CrossRefPubMed
14.
Zurück zum Zitat 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 48:2053–2069CrossRefPubMed 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 48:2053–2069CrossRefPubMed
15.
Zurück zum Zitat Sluysmans T, Colan SD (2005) Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol 99:445–457CrossRefPubMed Sluysmans T, Colan SD (2005) Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol 99:445–457CrossRefPubMed
16.
Zurück zum Zitat Gutgesell HP, Rembold CM (1990) Growth of the human heart relative to body surface area. Am J Cardiol 65:662–668CrossRefPubMed Gutgesell HP, Rembold CM (1990) Growth of the human heart relative to body surface area. Am J Cardiol 65:662–668CrossRefPubMed
17.
Zurück zum Zitat Abbott RD, Gutgesell HP (1994) Effects of heteroscedasticity and skewness on prediction in regression: modeling growth of the human heart. Methods Enzymol 240:37–51CrossRefPubMed Abbott RD, Gutgesell HP (1994) Effects of heteroscedasticity and skewness on prediction in regression: modeling growth of the human heart. Methods Enzymol 240:37–51CrossRefPubMed
18.
Zurück zum Zitat 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 5:791–796CrossRefPubMed 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 5:791–796CrossRefPubMed
19.
Zurück zum Zitat 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 24:214–218CrossRefPubMed 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 24:214–218CrossRefPubMed
20.
Zurück zum Zitat Wang Y, Gutman JM, Heilbron D, Wahr D, Schiller NB (1984) Atrial volume in a normal adult population by two-dimensional echocardiography. Chest 86:595–601CrossRefPubMed Wang Y, Gutman JM, Heilbron D, Wahr D, Schiller NB (1984) Atrial volume in a normal adult population by two-dimensional echocardiography. Chest 86:595–601CrossRefPubMed
21.
Zurück zum Zitat 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):734–739CrossRefPubMed 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):734–739CrossRefPubMed
22.
Zurück zum Zitat 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 106:1345–1350CrossRefPubMed 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 106:1345–1350CrossRefPubMed
23.
Zurück zum Zitat 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):617–623CrossRefPubMed 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):617–623CrossRefPubMed
24.
Zurück zum Zitat 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 33:209–218CrossRefPubMed 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 33:209–218CrossRefPubMed
Metadaten
Titel
Validation of Right Atrial Area as a Measure of Right Atrial Size and Normal Values of in Healthy Pediatric Population by Two-Dimensional Echocardiography
verfasst von
Hari Rajagopal
Santosh C. Uppu
Justin Weigand
Simon Lee
Ruchika Karnik
Helen Ko
Puneet Bhatla
James Nielsen
John Doucette
Ira Parness
Shubhika Srivastava
Publikationsdatum
09.03.2018
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 5/2018
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-018-1838-3

Weitere Artikel der Ausgabe 5/2018

Pediatric Cardiology 5/2018 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.