1University Hospital Basel, Department of Cardiology, Basel, Switzerland2University Hospital Basel, Department of Radiology, Basel, Switzerland3Kantonsspital Liestal, Department of Cardiology, Liestal, Switzerland
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Purpose: To validate a novel real-time three-dimensional echocardiography (3DRTE) analysis tool exclusively dedicated to the functional evaluation of the left atrium (LA). Cardiac magnetic resonance imaging (MRI) served as standard of reference.Methods: Forty consecutive patients scheduled for pulmonary vein isolation that underwent clinically indicated cardiac MRI were prospectively included. 3DRTE was performed prior to MRI and a dynamic polyhedron model of the LA was generated (Figure 1A), enabling the calculation of LA maximum and minimum volumes (LAmax / LAmin) (Figure 1B), atrial emptying fraction (LAEF), and true atrial ejection fraction (trueLAEF). Functional parameters obtained by 3DRTE were compared to the results obtained by MRI.Results: High intraclass correlations between RT3DE and MRI were found for LAmax (r=0.97, p<0.001), LAmin (r=0.97, p<0.001), LAEF (r=0.94, p<0.001), and trueLAEF (r=0.98, p<0.001). Similarly, Bland-Altmann analysis revealed narrow limits of agreement for LAmax (-29.6 to 13.5mL), LAmin (-27.9 to 11.9mL), LAEF (-10.3 to 13.3%), and trueLAEF (-9.5 to 6.4%). Of note, while measurements of LAmax and LAmin were significantly (p<0.001) lower by RT3DE (108±36mL vs. 118±39mL and 68±39mL vs. 77±38mL, respectively), no significant difference was found for LAEF and trueLAEF between the two modalities (39±15% vs. 37±17% and 22±14% vs. 27±13%, respectively).Conclusions: Left atrial echocardiographic parameters obtained by 3DRTE and assessed by a dedicated software tool correlate highly with MRI measurements, thus enabling rapid and accurate, yet low-cost quantitative assessment of LA size and function.