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  1. L’atrio sinistro conferme e novità A. Sulla e R. Lumare Unità Operativa di Cardiologia – UTIC P.O. San Giovanni di Dio Crotone “Incontri Pitagorici di Cardiologia 2010” 1 - 2 Ottobre 2010 - Crotone

  2. Come deve essere studiato l’atrio sinistro ?

  3. 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 Roberto M. Lang, MD, Michelle Bierig, MPH, RDCS, Richard B. Devereux, MD, Frank A. Flachskampf, MD, Elyse Foster, MD, Patricia A. Pellikka, MD, Michael H. Picard, MD, Mary J. Roman, MD, James Seward, MD, Jack S. Shanewise, MD, Scott D. Solomon, MD, Kirk T. Spencer, MD, Martin St John Sutton, MD, William J. Stewart, MD and Members of the Chamber Quantification Writing Group Journal of the American Society of Echocardiography Volume 18, Issue 12, Pages 1440-1463 (December 2005)

  4. Dimensione lineare Journal of the American Society of Echocardiography 2005; 18:1440-1463

  5. Raccomandazioni ASE-EAE ……..AP linear dimensions of the LA as the sole measure of LA size may be misleading and should be accompanied by LA volume determination in both clinical practice and research. …… when LA size is measured in clinical practice, volume determinations are preferred over linear dimensions because they allow accurate assessment of the asymmetric remodeling of the LA chamber. Journal of the American Society of Echocardiography Volume 18, Issue 12, Pages 1440-1463 (December 2005)

  6. Area e volume bidimensionale Journal of the American Society of Echocardiography 2005; 18:1440-1463

  7. Lester Am J Cardiol 1999; 84:829

  8. Perché è importante la determinazione delle dimensioni?

  9. Left Atrium Size and the Riskof Cardiovascular Death in Middle-aged Men

  10. Razionale della valutazione dell’atrio sin. Abhayaratna W.P. JACC 2006:47-12

  11. Prediction of Cardiovascular Outcomes With Left Atrial SizeIs Volume Superior to Area or Diameter? Tsang S.M., J Am CollCardiol 2006; 47:1018 –23

  12. Left Atrial Size by Planimetry is Superior to M-mode Diameter: Biochemical Calibration by Atrial and BrainNatriuretic Peptide Buchner, JASE 2008; 21-4,380

  13. Quale è la spiegazione ?

  14. LeftAtrial Volume as a MorphophysiologicExpressionofLeftVentricularDiastolicDysfunction r 0,78 r 0,48 Tsang S.M., AmJCardiol 2002; 90

  15. Relation to diastolic disfunction Receiver-operator curves for the detection of diastolic dysfunction (area under curves 0.95 for indexed LA volume, 0.82 forM-mode LA dimension, p 0.006; 0.83 for E/E, p 0.002)

  16. Kaplan-Meier survival curves demonstrating the relationships between severity of diastolic dysfunction (DD) (left) and left atrial (LA) volume index and survival Pritchett, A. M. et al. J Am CollCardiol 2005;45:87-92

  17. Il volume atriale sinistro meglio riflette, rispetto ad altri indici, la severità della disfunzione diastolica e la prolungata esposizione della camera atriale ad un alterata funzione diastolica ed elevate pressioni di riempimento e come la disfunzione diastolica ha un forte legame con la prognosi.

  18. L’informazione prognostica è aggiuntiva ed indipendente ?

  19. Left Atrial Volume Is a Predictor of Atrial Fibrillation Recurrence After Catheter Ablation Sung-HeeShin, JASE 2008

  20. Determinants and Prognostic Value of Left Atrial Volume in Patients With Dilated Cardiomyopathy Rossi et al., JACC Vol. 40, No. 8, 2002

  21. Left Atrial VolumeA Powerful Predictor of Survival After Acute Myocardial Infarction Moller, Circulation2003;107

  22. Long-term prognostic significance of left atrial volume in acute myocardial infarction Beinart, JACC 2004;44

  23. Independent relationship of left atrial size and mortality in patients with heart failure: an individual patient meta-analysis of longitudinal data (MeRGE Heart Failure) Rossi, Eur J ofHeartFailure ; 2009-11

  24. Impact of Left Atrial Volume on Clinical Outcome in Organic Mitral Regurgitation Le Tourneau, JACC 2010;56

  25. Prognostic Significance of Left Atrial Volume Dilatation in Patients with Hypertrophic Cardiomyopathy Losi MA, J Am SocEchocardiogr 2009;22:76-81.)

  26. La dilatazione dell’atrio sin. comporta importanti implicazioni cliniche e prognostiche. La determinazione del volume è superiore al diametro AP come misura delle dimensioni atriali. Le attuali lineeguida sconsigliano la determinazione con misura lineare. La determinazione del volume aggiunge informazioni che hanno importante valore prognostico aggiuntivo ed indipendente da altri fattori. La valutazione del volume dovrebbe essere quindi inserita nella valutazione ecocardiografica di routine. Conclusioni