Left atrial size quantification using non-contrast-enhanced cardiac computed tomography – association with cardiovascular risk factors and gender-specific distribution in the general population: the Heinz Nixdorf Recall study

Abstract

Background

Left atrial (LA) size is associated with cardiovascular mortality and morbidity. Once cardiac computed tomography (CT) is performed, information on LA size is readily available without additional contrast media or radiation exposure.

Purpose

To determine the association of CT-derived LA area and body surface area-adjusted (BSA) LA index with cardiovascular risk factors and describe age- and gender-specific normative values in a general population cohort.

Material and Methods

This study included 3945 participants (mean age, 59 ± 8 years; 53% women) from the community-based Heinz Nixdorf Recall Study. LA area in an axial image at the level of the mitral valve was quantified from non-contrast-enhanced electron-beam CT by manual delineations of the boundaries of the LA with exclusion of subjects with prevalent cardiovascular disease. Definition of normative values was performed in subjects without predictors of LA enlargement.

Results

LA quantification was feasible in all subjects. Men had larger LA size (1856 mm² vs. 1677 mm², P < 0.0001), while after adjustment for BSA, this effect was inverted (910 mm²/m² vs. 933 mm²/m² for men and women, P < 0.0001). Determinants of body size were major predictors of LA size (body mass index [BMI]: R²= 0.195, BSA: R²= 0.216, both P < 0.0001). Blood pressure was associated with LA size (parameter-estimate [95% confidence interval] = 51.0 (4.9–57.1) mm²/10 mmHg for systolic, 31.4 (25.4–37.4) mm²/5 mmHg for diastolic blood pressure, 214.6 (186.9–242.3) mm² for antihypertensive medication, P < 0.0001 for all). Cholesterol levels, lipid-lowering therapy, and diabetes were associated with LA in univariable analysis, however, correlations were low (r²≤ 0.026). Current smoking was associated with reduced LA size (–115.9 [–149.0 – –82.8] mm², P < 0.0001). In multivariable regression, BMI, blood pressure, antihypertensive medication, and smoking remained associated with LA size (P < 0.005).

Conclusion

Non-contrast-enhanced cardiac CT enables LA quantification with body size, hypertension, and smoking status being predictors of LA size.

Keywords

Left atrium computed tomography cardiovascular disease risk factors Heinz Nixdorf Recall Study epidemiology

Get full access to this article

View all access options for this article.

References

Tsang

Barnes

Gersh

. Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography. J Am Coll Cardiol 2003; 42: 1199–1205.

Tsang

Abhayaratna

Barnes

. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol 2006; 47: 1018–1023.

Kizer

Bella

Palmieri

. Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: the Strong Heart Study (SHS). Am Heart J 2006; 151: 412–418.

Benjamin

D’Agostino

Belanger

. Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 1995; 92: 835–841.

Lang

Bierig

Devereux

. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463.

Mahabadi

Samy

Seneviratne

. Quantitative assessment of left atrial volume by electrocardiographic-gated contrast-enhanced multidetector computed tomography. J Cardiovasc Comput Tomogr 2009; 3: 80–87.

Mahabadi

Truong

Schlett

. Axial area and anteroposterior diameter as estimates of left atrial size using computed tomography of the chest: comparison with 3-dimensional volume. J Cardiovasc Comput Tomogr 2010; 4: 49–54.

Christiaens

Lequeux

Ardilouze

. A new method for measurement of left atrial volumes using 64-slice spiral computed tomography: Comparison with two-dimensional echocardiographic techniques. Int J Cardiol 2009; 131: 217–224.

Avelar

Durst

Thangaroopan

. Accuracy of multi-detector computed tomography evaluation of left atrial volume for prognostic evaluation: a phantom and echo correlation study. J Am Coll Cardiol 2008; 51: A153–A153.

10.

Stolzmann

Scheffel

Trindade

. Left ventricular and left atrial dimensions and volumes: comparison between dual-source CT and echocardiography. Invest Radiol 2008; 43: 284–289.

11.

Erbel

Mohlenkamp

Moebus

. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 2010; 56: 1397–1406.

12.

Greenland

Bonow

Brundage

. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). Circulation 2007; 115: 402–426.

13.

Schmermund

Mohlenkamp

Stang

. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk factors, evaluation of coronary calcium and lifestyle. Am Heart J 2002; 144: 212–218.

14.

Schmermund

Lehmann

Bielak

. Comparison of subclinical coronary atherosclerosis and risk factors in unselected populations in Germany and US-America. Atherosclerosis 2007; 195: e207–e216.

15.

Mosteller

. Simplified calculation of body surface area. N Engl J Med 1987; 317: 1098–1098.

16.

Moebus

Stang

Mohlenkamp

. Association of impaired fasting glucose and coronary artery calcification as a marker of subclinical atherosclerosis in a population-based cohort–results of the Heinz Nixdorf Recall Study. Diabetologia 2009; 52: 81–89.

17.

Jockel

Lehmann

Jaeger

. Smoking cessation and subclinical atherosclerosis–results from the Heinz Nixdorf Recall Study. Atherosclerosis 2009; 203: 221–227.

18.

Egan

Zhao

Axon

. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010; 303: 2043–2050.

19.

Agatston

Janowitz

Hildner

. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827–832.

20.

Wen

Zhang

. Assessing the left atrial phasic volume and function with dual-source CT: comparison with 3T MRI. Int J Cardiovasc Imaging 2010; 26(Suppl. 1): 83–92.

21.

Lin

Devereux

Roman

. Cardiac chamber volumes, function, and mass as determined by 64-multidetector row computed tomography: mean values among healthy adults free of hypertension and obesity. J Am Coll Cardiol 2008; 1: 782–786.

22.

McManus

Xanthakis

Sullivan

. Longitudinal tracking of left atrial diameter over the adult life course: Clinical correlates in the community. Circulation 2010; 121: 667–674.

23.

Jorgensen

Muller

Nel

. Reduced intrathoracic blood volume and left and right ventricular dimensions in patients with severe emphysema: an MRI study. Chest 2007; 131: 1050–1057.