Diameter of Left Atrial Changes ??

[Jerry_NJ]

This is also posted on "Heart Rhythm Community"

I have an enlarged left atrium due, at least in part, to a history of a leaky mitral valve.  In July of 2007 the diameter was measured by echocardiogram at 5 cm.  The range for normal is given as 1.5 to 4.0.   The left atrium had been smaller in the echocardiogram about 3 years previous, and the leaky mitral valve was noted.  Prior to the July test, I had responded reasonably well to electrocardioversion to convert my AFig.  A couple of these lasted about 18 months each.  

I underwent open heart surgery in November of 2007 to repair the mitral valve.  Following healing I underwent another echocardiogram and the left atrium diameter was measured at 5.11 cm.  None the less, we tried a electrocardioversion in August of 2008 and it did not hold.  NSR lasted about on week.  

Then in August 2009 I underwent a follow-up check with an echocardiogram and the left atrium came in at 4.5 cm.  This was good news, but not a surprise to me as my surgeon said the mitral valve repair should result in some shrinkage of the enlarged left atrium.  I talked with my cardiologist about trying another electrocardioversion, and he said that seems reasonable, but wait another 6 months and again measure the atrium by echo.  That was done on March 25, 2010.  

Now the bad news, I think.  The left atrium measures the largest ever at 5.5 cm.  I have a follow-up appointment with my cardiologist and we will discuss this last test.

I know I have read somewhere, maybe on this community, that the measurement of the "diameter" of the atrium (or any chamber) is not very accurate - and thus, may I assume, may vary from test to test even if there is no change in the size?

[Jerry_NJ]

Thanks for the insights from a professional.  

I am getting ready to update my "condition" due to a heart rate control medication addition of a Calcium Channel Blocker - wow, it is really working.

My program is live with AFig:  reduce clot risk with Warfarin and reduce (ventricle) heart rate with meds, now BB and CCB.

[gernansky]

I am a cardiovascular sonographer in OKC, OK.  I found this forum by searching for papers regarding this exact subject.  

Everything you all have discussed here rings true for me.  Try to remind yourself when looking at your measurements what a centimeter is.  Then think about splitting hairs over .4 cm.  

There are, of course, variables as you've discussed ie. heart position, volume changes for any number of reasons such as patient position, patient hydration, etc.

Also there is (gulp) technologist error :)  Yes, it is true - we are not perfect.  But I do try to be and, in the end, when I take a measurement I take my time.  I average about 30 minutes of scanning per Echo.  Sometimes it takes as much as an hour on a very difficult patient.  But even with crystal clear images and normal findings, it should take AT LEAST 20 minutes.  

I've been doing ultrasound exams for 17 years and I could easily whip out all of the measurements in 10-15 minutes.   But, I refuse to do this for many reasons both ethical and professional.  I want to provide  accurate data for the benefit of the patient's diagnosis and the way I see it is that my job and career are on the line every time I turn one in.   At least, that's what I tell myself to keep my standards high.

I could ramble on forever about this subject and even about LA Dimensional variations and measuring techniques, but, let me just summerize by saying I wouldn't sweat the numbers you're sharing if it was me. I immagine you are on blood thinners for your arrhythmia already and that is the key treatment for a large LA as you become more susceptible to thrombus/clot development in the chambers do to "stasis" of the blood.

I'll try to remember to come back here and answer and follow-up questions you might have.

Jay  
(BTW - I grew up in Elizabeth/Westfield/ and Forked River N.J. till I was about 10)

[erijon]

No problem, I know what you're going through. My LA has been measured at 4.9 cm since 2006. I asked my cardiologist about it and she was not concerned and told me that it rarely has any prognostic value unless you are symptomatic. I hesitate to comment on your situation as you have a history of miitral valve issues. In my case, my cardiologist said my LA may just be the right size for me. Also, I had lost 70 pounds so it is also common for the heart to shift it's axis so when the echo takes a "slice", it's like cutting a banana at a 45 degree angle compared to 90 degrees As you can imagine, the slice at 45 degrees would show a larger surface area which is a common reason that echos are not accurate.

Hope it works out for you, good luck,

Jon

[Jerry_NJ]

Thanks Jon.

I have a follow up appointment in about 3 weeks, and as the echo didn't show anything dangerous that's when I'll be able to talk with my doctor.  

It is encouraging to read that the echo isn't particularly accurate in measuring the size of heart chambers.  I note my EF is good at 60% and that is consistent echo to echo.  The large variation on the atrium size was troubling to my mind, but the lack of repeatability of the measure may be mostly due to it being subject to many uncontrollable, like I may be holding my left arm in a different position, changing the echo path...

[erijon]

An echo is not always the most accurate way to measure LA size. The most accurate way is by a LA volume test which calculates the size based on the volume of blood in the chamber. You may want to discuss this with your cardiologist.

Good luck,

Jon