| Objective:The accuracy of the echocardiographic left atrial measurement method was evaluated using CTA as a standard.Method:Between September 2018 and January 2019,142 patients(92 males and 50 females)with atrial fibrillation in our department of Cardiology were treated with Computed Tomography Angiography(CTA)and Transthoracicechocardiography(TTE)examination.The CTA uses a post-processing workstation for left atrial reconstruction to automatically measure left atrial volume;echocardiography uses four methods(ellipsoidal,cubic,biplane A/L,dual plane Simpson's)to measure left atrial volume and measure Left atrial anteroposterior diameter,lateral diameter,long diameter and total diameter;calculate the volume index and the dimensional index by the body surface area(BSA).The Bland-Altman curve,box plot and intra-group correlation coefficient(ICC)were used to evaluate the consistency and bias of the ultrasound measurement parameters with CTA,and the correlation was evaluated by Person's correlation test.Using the CTA as a standard,the accuracy of different methods of ultrasound was compared using the ROC curve.Results:(1)The various methods of echocardiographic measurement of LAVI are strongly correlated with CTA(r>0.8).The biplane A/L method calculates the minimum percentage difference with CTA three-dimensional reconstruction in LAVI,which is smaller than CTA(24±11)%,followed by the two-plane Simpson's method,which is on average smaller than CTA(28±12)%.The ellipsoid and cube methods significantly underestimated the left atrial volume,and the volume index was 61%and 66%smaller than the CTA,but the Bland-Altman plots illustrate the wide limits of agreement,which is clinically unacceptable,so they are irreplaceable.(2)The anteroposterior diameter,long diameter and total diameter of the left atrium were strongly correlated with the left atrial volume of the CTA.The left atrium total diameter was the best,and the lateral diameters were the worst.(3)According to the LAVI measured by CTA,the area under the ROC curve of the left atrium anteroposterior diameter and total diameter is the largest in the radial line,and the cut-off point is 3.95 cm(sensitivity 85.1%,specificity 86.3%),13.05 cm(sensitivity90.0%,specificity 77.6%);Among dimensional index the area under the ROC curve of the left atrial anteroposterior dimensional index and the left atrial total dimensional index was the largest,and the cut-off point was 2.46 cm/m~2(sensitivity 80.0%,specificity 89.7%),8.65 cm/m~2(sensitivity 80.0%,specificity 98.3%).The dimensional index indexed by the body surface area is slightly better than the absolute value of the diameter line.(4)Among volumetric methods,biplane A/L method and biplane Simpson's method have the largest area under ROC curve,with the cutoff points of 69.65ml(sensitivity 80.0%,specificity 91.4%)and 65.65ml(sensitivity90.0%,specificity 87.9%)respectively;In volumetric index,the area under ROC curve of biplane A/L method and biplane Simpson's method is the largest,with cutoff points of 34.22ml/m~2(sensitivity 90.0%,specificity 74.1%)and 35.89ml/m~2(sensitivity 90.0%,specificity 81.0%)respectively.The volume index that indexed by surface area are better than the absolute values of volume.Conclusion:Echocardiography,as the imaging examination with the highest utilization rate for clinical cardiac related diseases,has numerous indexes for analyzing the size of left atrium.This study suggests that:(1)The total diameter and anteroposterior diameter is better than the other left atrium diameters.The biplane A/L method and the biplane Simpson's method of left atrial volume performed better than other methods of measuring volume by ultrasound.(2)The volume index and dimensional index that standardized by body surface area evaluate the size of left atrium more accurately.(3)The volume of left atrium measured by echocardiography was smaller than measured by CTA. |
PDF Full Text Request