Variations in indexation of left atrial volume across different races
Aaisha Ferkh,
Faraz Pathan,
Eddy Kizana,
James Elhindi,
Amita Singh,
Cristiane Carvalho Singulane,
Tatsuya Miyoshi,
Federico M. Asch,
Roberto M. Lang,
Liza Thomas,
Aldo D. Prado,
Karima Addetia,
Michele Bellino,
Masao Daimon,
Pedro Gutierrez Fajardo,
Ravi R. Kasliwal,
James N. Kirkpatrick,
Mark J. Monaghan,
Denisa Muraru,
Kofo O. Ogunyankin,
Seung Woo Park,
Ricardo E. Ronderos,
Anita Sadeghpour,
Gregory M. Scalia,
Masaaki Takeuchi,
Wendy Tsang,
Edwin S. Tucay,
Ana Clara Tude Rodrigues,
Amuthan Vivekanandan,
Yun Zhang
Affiliations
Aaisha Ferkh
Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia; University of Sydney, Camperdown, Sydney, NSW, Australia
Faraz Pathan
Department of Cardiology, Nepean Hospital, Nepean, NSW, Australia
Eddy Kizana
Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia; University of Sydney, Camperdown, Sydney, NSW, Australia
James Elhindi
University of Sydney, Camperdown, Sydney, NSW, Australia
Amita Singh
University of Chicago, Chicago, IL, USA
Cristiane Carvalho Singulane
University of Chicago, Chicago, IL, USA
Tatsuya Miyoshi
MedStar Health Research Institute, Washington, DC, USA
Federico M. Asch
MedStar Health Research Institute, Washington, DC, USA
Roberto M. Lang
University of Chicago, Chicago, IL, USA
Liza Thomas
Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia; University of Sydney, Camperdown, Sydney, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Corresponding author. Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia.
Background: Left atrial volume (LAV) has prognostic value. Guidelines propose indexation to body surface area (BSA), however studies demonstrate this can overcorrect for body size. Limited studies investigate indexation across different ethnicities. We sought to evaluate the effect of ethnicity on indexation. Methods: Using data from the World Alliance of Societies of Echocardiography (WASE) cohort, healthy subjects were classified by race as White, Black, Asian, or Other. Biplane LAV was indexed to traditional isometric measurements (BSA, height, weight, ideal body weight (IBW) and IBW derived BSA (IBSA)), as well as previously-derived allometric height exponents (2.7 and 1.72). Additionally, an allometric height exponent for our cohort was derived (linear regression of the logarithmic transformation of LAV = a(height)b) as 1.87. All indices were then assessed using Spearman correlation, with a good index retaining correlation of LAV/index to raw LAV (r∼1), while avoiding overcorrection by the index (r∼0). Results: There were 1366 subjects (White: 524, Black: 149, Asian: 523, Other: 170; median age 44 years, 653 females (47.8%)). In the entire group, BSA, IBSA, height1.87 and height1.72 performed well with retaining correlation to raw LAV (r > 0.9 for all), and minimising overcorrection to body size (r < 0.1 for all). On race-specific analysis, BSA overcorrected for body size in the White population (r = 0.128). Height1.72 minimised overcorrection for body size in all populations (r ≤ 0.1 for all races). Conclusion: Despite a cohort with normal BMI, there was still disparity in LAV indexation with BSA across races. Allometric height indexation, particularly using height1.72, is a possible solution, although further validation studies in BMI extremes are required.
