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Left Atrial Function and Maximum Volume as Determined by MDCT Are Independently Associated with Atrial Fibrillation

Posted Aug 31, 2014 Updated Apr 10, 2023
By Jadranka Stojanovska MD MS , Paul Cronin MD MS , Barry H. Gross MD , Ella A. Kazerooni MD MS , Alex Tsodikov PhD , Luba Frank MD , Hakan Oral MD PhD
17 min read

Rationale and Objectives

To assess whether left atrial (LA) volume, function, and diameter as determined by multidetector computed tomography (MDCT) are associated with the presence and chronicity of atrial fibrillation (AF).

Materials and Methods

A total of 232 subjects, 156 with AF (43 with chronic and 113 with paroxysmal) and 76 normal subjects, formed the study population. AF subjects underwent MDCT of the pulmonary veins and LA, and normal subjects underwent coronary computed tomography (CT), on which LA volume, function, and diameter were measured. Associations between each MDCT LA parameter and presence and chronicity of AF were assessed using logistic regression analysis.

Results

The indexed LA maximum volume (odds ratio [OR] = 2.42; 95% confidence interval [CI], 1.43–4.08; P = .0009) was significantly associated with chronicity and presence of AF (OR = 1.06; 95% CI, 1.03–1.10; P = .0003) after adjustment for traditional risk factors. The LA function was associated with presence of AF (OR = 0.93; 95% CI, 0.89–0.97; P = .0005), but not with AF chronicity (OR = 1.12; 95% CI, 0.93–1.33; P = .21).

Conclusions

Decreased LA function is associated with presence of AF, and increased LA maximum volume is associated with presence and chronicity of AF, independent of traditional risk factors.

Key points:

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Materials and methods

Study Design and Population

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Figure 1, This figure illustrates study design. AF, atrial fibrillation; CT, computed tomography; LA, left atrium.

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ECG-Gated Pulmonary Vein and LA MDCT

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ECG-Gated CCT

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Image Postprocessing

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LA Function and Volume

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Figure 2, Computed tomography (CT) imaging of the left atrium in a 36-year-old healthy male with no cardiovascular risk factors and no atrial fibrillation. (a) CT: long axis of the heart-reformatted image demonstrates endocardial tracing ( red circle ) of the left atrium in its end-diastolic phase. (b) CT: long axis of the heart-reformatted image demonstrates endocardial tracing ( red circle ) of the left atrium in its end-systolic phase. (c) CT: long axis of the heart demonstrates the left atrium with maximum volume. The green horizontal black line in anteroposterior direction denotes the left atrial diameter. (Color version of figure is available online.)

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Definitions of MDCT LA Measurements

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Risk Factor and Covariate Assessment

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Statistical Analysis

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Results

Study Subjects

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Table 1

Study Sample Characteristics Presented as Mean ± SD or Median (IQR) when Appropriate

(a) Groups Normal Subjects ( n = 76) Patients with AF ( n = 156)P Value ∗ Age, years 48 (39–58) 59 (52–64) <.0001 † Women, n (%) 37 (48) 45 (29) .003 † Weight, kg 81 (72–91) 95 (81–106) <.0001 † Height, m 1.7 (1.6–1.8) 1.8 (1.7–1.8) .0001 † BMI, kg/m 2 27 (24–31) 28 (26–33) .01 † BSA 1.9 ± 0.2 2.2 ± 0.3 <.0001 † SBP, mm Hg 122 ± 10 123 ± 20 .30 DBP, mm Hg 73 ± 9 75 ± 11 .43 HR, bpm 73 ± 12 78 ± 15 .02 † CAD, n (%) 0 (0) 14 (9) .006 † Hypertension, n (%) 0 (0) 82 (51) <.0001 †

(b) Groups Paroxysmal AF ( n = 113) Chronic AF ( n = 43)P Value ∗ Age, years 58 (51–63) 61, 56-66 .11 Women, n (%) 35 (31) 10 (23) .43 Weight, kg 91 (79–106) 98 (87–111) .01 † Height, m 1.8 (1.7–1.8) 1.8 (1.7–1.9) .12 BMI, kg/m 2 28 (25–32) 30 (27–34) .05 † BSA 2.1 ± 0.3 2.2 ± 0.3 .01 † SBP, mm Hg 121 ± 19 128 ± 21 .06 DBP, mm Hg 72 ± 9 82 ± 11 <.0001 † HR, bpm 77 ± 15 79 ± 15 .56 CAD, n (%) 8 (7) 6 (14) .21 Hypertension, n (%) 50 (44) 32 (74) .001 †

AF, atrial fibrillation; BMI, body mass index; bpm, beats per minute; BSA, body surface area; CAD, coronary artery disease; DBP, diastolic blood pressure; HR, heart rate; SBP, systolic blood pressure; SD, standard deviation.

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AF and LA Volume and LA Diameter

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Table 2

Left Atrial Function, Volume, and Diameter (Absolute and Indexed Values) in Normal Patients and Patients with AF (Mean ± SD, 95% Confidence Interval)

Group Normal AF_P_ Value ∗ N 76 156 Absolute values LA EDV (mL) 80 ± 20 (75–84) 115 ± 33 (110–120) <.0001 † LA ESV (mL) 40 ± 13 (37–43) 79 ± 35 (73–84) <.0001 † LA SV (mL) 40 ± 10 (38–42) 35 ± 18 (32–38) .07 LA EF (%) 50 ± 9 (48–52) 33 ± 16 (30–35) <.0001 † LA diameter (mm) 31 ± 4 (30–32) 41 ± 7 (40–42) <.0001 † Indexed to BSA LA EDV/BSA (mL/m 2 ) 40 ± 9 (38–42) 54 ± 16 (51–56) <.0001 † LA ESV/BSA (mL/m 2 ) 20 ± 6 (19–21) 37 ± 17 (34–40) <.0001 † LA SV/BSA (mL/m 2 ) 20 ± 5 (19–21) 16 ± 8 (15–17) .001 † LA diameter (mm) 16 ± 2 (15–16) 19 ± 3 (18–19) <.0001 †

BSA, body surface area; EDV, end-diastolic volume; EF, ejection fraction; ESV, end-systolic volume; LA, left atrium; STD, standard deviation; SV, stroke volume.

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Table 3

Left Atrial Function, Volume and Diameter (Absolute and Indexed Values) in Paroxysmal and Chronic Atrial Fibrillation (Mean ± SD, 95% Confidence Interval)

Type of Atrial Fibrillation Paroxysmal Chronic_P_ Value ∗ N 113 43 Absolute values LA EDV (mL) 108 ± 29 (102–114) 132 ± 36 (121–143) .0002 † LA ESV (mL) 66 ± 25 (61–71) 112 ± 36 (102–124) <.0001 † LA SV (mL) 42 ± 14 (39–44) 17 ± 14 (13–22) <.0001 † LA EF (%) 39 ± 13 (37–42) 17 ± 13 (13–21) <.0001 † LA diameter (mm) 39 ± 6 (38–40) 46 ± 5 (44–48) <.0001 † Indexed to BSA LA EDV/BSA (mL/m 2 ) 52 ± 14 (49–55) 59 ± 17 (54–65) .01 † LA ESV/BSA (mL/m 2 ) 32 ± 13 (29–34) 51 ± 17 (45–56) <.0001 † LA SV/BSA (mL/m 2 ) 20 ± 6 (18–21) 8 ± 6 (6–10) <.0001 † LA diameter (mm) 19 ± 3 (18–20) 21 ± 3 (20–22) .006 †

BSA, body surface area; EDV, end-diastolic volume; EF, ejection fraction; ESV, end-systolic volume; LA, left atrium; STD, standard deviation; SV, stroke volume.

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Table 4

Left Atrial Function, Volume and Diameter (Absolute and Indexed Values) in Normal Patients and Patients with Atrial Fibrillation (Mean ± SD, 95% Confidence Interval)

Groups Normal Paroxysmal AF Nonparoxysmal AF_P_ Value ∗ Females Absolute values N 37 35 10 LA EDV (mL) 74 ± 18 (68–80) 104 ± 29 (94–114) 115 ± 33 (95–135) <.0001 † LA ESV (mL) 34 ± 11 (30–37) 64 ± 26 (55–73) 105 ± 30 (86–124) <.0001 † LA SV (mL) 40 ± 10 (37–43) 40 ± 14 (35–45) 11 ± 6 (7–15) <.0001 † LA EF (%) 55 ± 7 (53–57) 39 ± 14 (34–44) 9 ± 5 (6–12) <.0001 † LA diameter (mm) 31 ± 4 (30–32) 38 ± 6 (36–40) 45 ± 5 (42–48) <.0001 † Indexed to BSA LA EDV/BSA (mL/m 2 ) 40 ± 9 (37–43) 56 ± 16 (51–61) 57 ± 20 (45-69) <.0001 † LA ESV/BSA (mL/m 2 ) 18 ± 6 (16–20) 35 ± 14 (30–40) 52 ± 18 (41–63) <.0001 † LA SV/BSA (mL/m 2 ) 22 ± 5 (20–24) 21 ± 7 (19–23) 5 ± 3 (3–7) <.0001 † LA diameter/BSA (mm/m 2 ) 16 ± 2 (15–17) 20 ± 4 (19–21) 22 ± 3 (20–24) <.0001 † Males Absolute values N 39 78 33 LA EDV (mL) 86 ± 20 (80–92) 110 ± 30 (103–117) 137 ± 36 (125–149) <.0001 † LA ESV (mL) 46 ± 13 (42–50) 67 ± 25 (61–72) 115 ± 38 (102–128) <.0001 † LA SV (mL) 39 ± 11 (35–42) 42 ± 14 (39–45) 20 ± 16 (15–25) <.0001 † LA EF (%) 46 ± 7 (44–48) 40 ± 12 (37–43) 20 ± 14 (15–25) <.0001 † LA diameter (mm) 31 ± 4 (30–32) 39 ± 7 (37–41) 47 ± 6 (45–49) <.0001 † Indexed to BSA LA EDV/BSA (mL/m 2 ) 41 ± 9 (38–44) 50 ± 14 (47–53) 60 ± 17 (54–66) <.0001 † LA ESV/BSA (mL/m 2 ) 22 ± 6 (20–24) 30 ± 11 (28–32) 50 ± 18 (44–56) <.0001 † LA SV/BSA (mL/m 2 ) 19 ± 5 (17–21) 19 ± 6 (18–20) 8 ± 7 (6–10) <.0001 † LA diameter/BSA (mm/m 2 ) 14 ± 2 (13–15) 18 ± 3 (17–19) 20 ± 3 (19–21) <.0001 †

AF, atrial fibrillation; BSA, body surface area; EDV, end-diastolic volume; ESV, end-systolic volume; LA, left atrium; SD, standard deviation; SV, stroke volume.

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Figure 3, Box and whisker plots of left atrial (LA) maximum volume and atrial fibrillation (AF). (a) Descriptive statistics (mean, median, 25th interquartile range, 75th interquartile range, maximum, and minimum) of left atrial absolute end-diastolic volume (EDV) in control group and patients with atrial fibrillation. (b) Descriptive statistics (mean, median, 25th interquartile range, 75th interquartile range, maximum, and minimum) of LA EDV across the three groups (control, paroxysmal AF, and nonparoxysmal AF).

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AF and LA Ejection Fraction

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Figure 4, Box and whisker plots of left atrial (LA) ejection fraction (EF) and atrial fibrillation (AF). Descriptive statistics (mean, median, 25th interquartile range, 75th interquartile range, maximum, and minimum) of LA EF in the control group and patients with AF are shown.

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Predictors of LA Volume

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LA Measurements and Presence of AF

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Table 5

Unadjusted and Adjusted ORs for LA MDCT Variables Used as Associations with the Presence of AF (AF vs. Normal Patients)

LA MDCT Unadjusted OR (95% CI) ∗ P Value Adjusted OR (95% CI) ∗ P Value Absolute LA MDCT values Maximum volume 1.05 (1.03–1.06) <.0001 † 1.03 (1.01–1.05) .0005 † Minimum volume 1.08 (1.05–1.05) <.0001 † 1.06 (1.03–1.08) .0001 † Stroke volume 0.98 (0.96–0.99) .02 † 0.99 (0.96–1.02) .49 Ejection fraction 0.91 (0.88–0.93) <.0001 † 0.93 (0.89–0.97) .0005 † Diameter 1.32 (1.23–1.42) <.0001 † 1.29 (1.17–1.42) <.0001 † Indexed LA MDCT values Maximum volume 1.08 (1.05–1.11) <.0001 † 1.06 (1.03–1.10) .0003 † Minimum volume 1.16 (1.11–1.21) <.0001 † 1.12 (1.06–1.09) <.0001 † Stroke volume 0.93 (0.89–0.97) .0004 † 0.97 (0.92–1.03) .31 Diameter 3.62 (0.76–17.21) .11 3.37 (0.55–20.82) .19

AF, atrial fibrillation; CI, confidence interval; LA, left atrium; MDCT, multidetector computed tomography; OR, odds ratio.

Adjusted absolute values for hypertension, coronary artery disease, age, sex, body surface area and body mass index. Adjusted indexed values for coronary artery disease, hypertension, gender and age.

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MDCT LA Measurements and AF Chronicity

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Table 6

Unadjusted and Adjusted ORs for LA MDCT Variables Used as Associations with AF Chronicity (Nonparoxysmal vs. Paroxysmal AF)

LA MDCT Unadjusted OR (95% CI) ∗ P Value Adjusted OR (95% CI) ∗ P Value Absolute LA MDCT values Maximum volume 1.31 (1.03–1.65) .02 † 1.48 (1.12–1.95) .005 † Minimum volume 0.79 (0.63–0.99) .04 † 0.71 (0.54–0.93) .01 † Stroke volume 0.65 (0.5–0.85) .002 † 0.55 (0.39–0.75) .0009 † Ejection fraction 1.08 (0.97–1.22) .35 1.12 (0.93–1.33) .21 Diameter 1.12 (1.04–1.25) .04 † 1.15 (0.98–1.35) .07 Indexed LA MDCT values Maximum volume 1.66 (1.06–2.61) .01 † 2.42 (1.43–4.08) .0009 † Minimum volume 0.61 (0.39–0.94) .03 † 0.43 (0.26–0.73) .001 † Stroke volume 0.46 (0.29–0.73) .001 † 0.31 (0.17–0.55) <.0001 † Diameter 1.03 (0.83–1.27) .89 1.22 (0.93–1.59) .15

AF, atrial fibrillation; CI, confidence interval; LA, left atrium; MDCT, multidetector computed tomography; OR, odds ratio.

Adjusted absolute values for hypertension, coronary artery disease, age, sex, body surface area and body mass index. Adjusted indexed values for coronary artery disease, hypertension, gender and age.

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Traditional Risk Factors and Nonparoxysmal AF

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Discussion

Main Findings

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MDCT LA Measures and Presence of AF

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MDCT LA Measures and Chronicity of AF

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LA Diameter Versus LA Maximum Volume

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MDCT Measures and Traditional Risk Factors

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Strengths and Limitations

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Clinical Implications

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Academic Radiology, Volume 21, Issue 9
Journals General Radiology
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