Left Atrial Pediatric Reference Volumes Using Real-Time 3D-Echocardiography

Background: Left atrial (LA) volumes have been shown to be of prognostic value regarding prognosis and risk stratifications of various heart diseases. Real-time 3D-echocardiography (RT3DE) is a promising non-invasive method to asses LA volumes. However, RT3DE reference values for in European children are lacking.

Methods: In a multicenter prospective study, in 218 healthy children and adolescents aged 1.5–256 months, RT3DE of the LA was performed (i.e., 33, Philips; Vivid 7, GE). LA volumes were assessed using TomTec-Imaging Systems Version 4.6.3.9 (4D LV-Function). Percentiles for maximal and minimal LA volumes were created using the LMS method. For estimation of accuracy, a pulsatile balloon phantom, mimicking the volume changes in the left atrium, underwent volume assessment by the same software, using 5 different maximal and minimal volumes (5–17 mL, rate: 120 bpm).¹

Results: Percentiles for boys and girls of maximal and minimal LA volumes could be assessed by RT3DE. Agreement between the actual volumes of the phantom balloons and the volumes assessed by TomTec was good with a small mean bias of 0.27 mL and good limits of agreement of -1.97–2.51 mL.

Conclusion: RT3DE is a potential non-invasive method for echocardiographic assessment of LA volumes. By providing percentiles for LA volumes assessed by RT3DE this method can be of use in clinical practice and research. As an outlook we will analyze the data of more healthy children, allowing for reference values based on an even bigger sample for future use. Moreover we intend to do a comparison to LA volumes assessed by magnetic resonance imaging. This study was funded by Fördergemeinschaft Deutsche Kinderherzzentren.