Document Detail

Left atrial volume and index by multi-detector computed tomography: comprehensive analysis from predictors of enlargement to predictive value for acute coronary syndrome (ROMICAT study).
MedLine Citation:
PMID:  19615769     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We aimed to identify the predictors of left atrial (LA) enlargement by multi-detector computed tomography (CT) and determine its association and predictive value for acute coronary syndrome (ACS).
BACKGROUND: LA enlargement is associated with myocardial ischemia and coronary artery disease (CAD) and is a strong predictor for cardiovascular events. These studies were performed primarily with echocardiography. With the rise of cardiac CT, LA volume can be readily measured.
METHODS: In 377 emergency department patients with chest pain, we performed 64-slice CT for coronary artery assessment. We derived LA volumes (LAV(max), LAV(min)) and indices (LAVI(max), LAVI(min)) using a threshold-based volumetric method.
RESULTS: Subjects, with cardiac risk factors or CAD by CT, had larger LA (ΔLAV(max) 9.1 ml, p=0.004; ΔLAV(min) 8.1 ml, p=0.001; ΔLAVI(max) 3.3 ml/m(2), p=0.03; ΔLAVI(min) 3.4 ml/m(2), p=0.006) than controls. Predictors of LA enlargement were related to risk factors for diastolic dysfunction. ACS risk was greater in patients with top quartile LAV(max) (odds ratio [OR] 3.4, p=0.02) and LAV(min) (OR 4.7, p=0.01) than lowest quartile, but not when indexed. Similarly, the predictive values of LA volumes were incrementally better when added to CT finding of indeterminate stenosis (LAV(max): C statistic 0.62 to 0.70, p=0.046; LAV(min): C statistic 0.65 to 0.73, p=0.008), but not when indexed.
CONCLUSIONS: Risk factors related to diastolic dysfunction are independent predictors of LA enlargement. LA enlargement by volumes are associated with a 3-5 fold increase risk for ACS and have incremental value for predicting ACS when added to the CT finding of indeterminate stenosis.
Quynh A Truong; Fabian Bamberg; Amir A Mahabadi; Michael Toepker; Hang Lee; Ian S Rogers; Sujith K Seneviratne; Christopher L Schlett; Thomas J Brady; John T Nagurney; Udo Hoffmann
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-07-16
Journal Detail:
Title:  International journal of cardiology     Volume:  146     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-17     Completed Date:  2011-05-03     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  171-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.
Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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MeSH Terms
Acute Coronary Syndrome / epidemiology,  radiography*,  ultrasonography
Cardiac Volume*
Cardiomegaly / epidemiology,  radiography*,  ultrasonography
Cohort Studies
Heart Atria / radiography
Middle Aged
Predictive Value of Tests
Prospective Studies
Risk Factors
Tomography, X-Ray Computed / methods*
Grant Support
K23 HL098370-03/HL/NHLBI NIH HHS; L30 HL093806-01/HL/NHLBI NIH HHS; L30HL093896/HL/NHLBI NIH HHS; R01 HL080053/HL/NHLBI NIH HHS; R01 HL080053/HL/NHLBI NIH HHS; R01 HL080053-03/HL/NHLBI NIH HHS; T32 HL076136-05/HL/NHLBI NIH HHS; T32HL076136/HL/NHLBI NIH HHS

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