Left atrial volume quantification using coronary calcium score scan: Feasibility, reliability and reproducibility analysis of a standardized approach

Abstract

Background: Left atrial volume (LAV) is an independent prognosticator of cardiovascular events. We investigated whether LAV could be accurately and reliably measured using coronary calcium score (CAC) scan. Methods: We retrospectively selected consecutive patients that underwent coronary CT angiography (CCTA) and CAC scans. A standardized approach to calculate LAV on images was implemented. The measurements of the LAV on CAC scans and CCTA were performed one to three weeks apart in a random fashion by two readers blinded to the results of each other. The LAV measurements from CAC scan were compared to those from CCTA using correlation analysis. Inter-observer and intra-observer agreement of LAV measurement using CAC scan was evaluated. Results: Final analysis included one hundred subjects, mean age 52 ± 12 years, 48% male. There was a trend of a marginally larger, albeit not clinically significant, mean LAV calculated using CAC scan compared to that using CCTA: 74.3 vs. 71.0 mL: p < 0.001; for reader 1, and 71.7 vs. 71.2 mL p = 0.06 for reader 2, respectively. LAV using CAC scan and CCTA were highly correlated (R = 0.954, p < 0.001 for reader1 and R = 0.945, p < 0.001 for reader 2). There was high reproducibility within each reader with ICC of 0.951 and 0.989 for readers 1 and 2, respectively (p < 0.001). Finally, there was high inter-observer agreement as indicated by R of 0.97 and ICC of 0.96 (p < 0.001 for both). Conclusions: Quantification of LAV from CAC scan using the proposed standardized approach is feasible, highly reliable and reproducible as compared to CCTA.