Journal of the American Society of Echocardiography
Volume 22, Issue 6 , Pages 649-656 , June 2009

Echocardiography in Cardiovascular Public Health: The Feigenbaum Lecture 2008

  • Teresa S.M. Tsang, MD

      Affiliations

    • Corresponding Author InformationReprint requests: Teresa S.M. Tsang, MD, Mayo Clinic, Division of Cardiovascular Diseases, 200 First Street SW, Rochester, MN 55901.

References 

  1. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25–e146
  2. Braunwald E. Shattuck Lecture. Cardiovascular medicine at the turn of the millenium: triumphs, concerns and opportunities. N Engl J Med. 1997;337:1360–1369
  3. Kurzweil R. Reprogramming biology. Sci Am. 2006;295:38
  4. Boult C, Christmas C, Durso SC, Leff B, Boult LB, Fried LP. Perspective: transforming chronic care for older persons. Acad Med. 2008;83:627–631
  5. Tsang TS, Petty GW, Barnes ME, O'Fallon WM, Bailey KR, Wiebers DO, et al. The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades. J Am Coll Cardiol. 2003;42:93–100
  6. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:119–125
  7. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Seward JB, Bailey KR, et al. Time trends of ischemic stroke incidence and mortality in patients diagnosed with first atrial fibrillation in 1980 to 2000: report of a community-based study. Stroke. 2005;36:2362–2366
  8. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna W, et al. Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades. Eur Heart J. 2006;27:936–941
  9. Miyasaka Y, Barnes ME, Bailey KR, Cha SS, Gersh BJ, Seward JB, et al. Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J Am Coll Cardiol. 2007;49:986–992
  10. American Heart Association. 2008 heart and stroke statistical update. Dallas, TX: American Heart Association; 2007;
  11. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–259
  12. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. Available at: http://www.cdc.gov/brfss/.
  13. Wang TJ, Parise H, Levy D, D'Agostino RB, Wolf PA, Vasan RS, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA. 2004;292:2471–2477
  14. Tsang TS, Barnes ME, Miyasaka Y, Cha SS, Bailey KR, Verzosa GC, et al. Obesity as a risk factor for the progression of paroxysmal to permanent atrial fibrillation: a longitudinal cohort study of 21 years. Eur Heart J. 2008;29:2227–2233
  15. Watanabe H, Tanabe N, Watanabe T, Darbar D, Roden DM, Sasaki S, et al. Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study. Circulation. 2008;117:1255–1260
  16. Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49:565–571
  17. Lee DS, Massaro JM, Wang TJ, Kannel WB, Benjamin EJ, Kenchaiah S, et al. Antecedent blood pressure, body mass index, and the risk of incident heart failure in later life. Hypertension. 2007;50:869–876
  18. Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–313
  19. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19–25
  20. Nemes A, Gavaller H, Csajbok E, Forster T, Csanady M. Obesity is associated with aortic enlargement and increased stiffness: an echocardiographic study. Int J Cardiovasc Imaging. 2008;24:165–171
  21. Van Putte-Katier N, Rooman RP, Haas L, Verhulst SL, Desager KN, Ramet J, et al. Early cardiac abnormalities in obese children: importance of obesity per se versus associated cardiovascular risk factors. Pediatr Res. 2008;64:205–209
  22. Mitchell GF, Vasan RS, Keyes MJ, Parise H, Wang TJ, Larson MG, et al. Pulse pressure and risk of new-onset atrial fibrillation. JAMA. 2007;297:709–715
  23. Tsang TS, Gersh BJ, Appleton CP, Tajik AJ, Barnes ME, Bailey KR, et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol. 2002;40:1636–1644
  24. Tsang T, Verzosa G, Barnes M, Al-Omari M, Bailey K, Cha S, et al. Central pulse pressure as a robust predictor of first atrial fibrillation: study of atrial fibrillation in high risk elderly. Circulation. 2008;118:S_1106
  25. Vaccarino V, Holford TR, Krumholz HM. Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol. 2000;36:130–138
  26. Najjar SS, Scuteri A, Lakatta EG. Arterial aging: is it an immutable cardiovascular risk factor?. Hypertension. 2005;46:454–462
  27. Lakatta EG. Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev. 2002;7:29–49
  28. Lakatta EG. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part III: cellular and molecular clues to heart and arterial aging. Circulation. 2003;107:490–497
  29. Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part II: the aging heart in health: links to heart disease. Circulation. 2003;107:346–354
  30. Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I: aging arteries: a “set up” for vascular disease. Circulation. 2003;107:139–146
  31. Klein AL, Bursto DJ, Tajik AJ, Zachariah PK, Bailey KR, Seward JB. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc. 1994;69:212–224
  32. Ruan Q, Nagueh SF. Effect of age on left ventricular systolic function in humans: a study of systolic isovolumic acceleration rate. Exp Physiol. 2005;90:527–534
  33. Frank KF, Bolck B, Brixius K, Kranias EG, Schwinger RH. Modulation of SERCA: implications for the failing human heart. Basic Res Cardiol. 2002;97(suppl):I72–I78
  34. Wuytack F, Raeymaekers L, Missiaen L. Molecular physiology of the SERCA and SPCA pumps. Cell Calcium. 2002;32:279–305
  35. Cartwright EJ, Schuh K, Neyses L. Calcium transport in cardiovascular health and disease—the sarcolemmal calcium pump enters the stage. J Mol Cell Cardiol. 2005;39:403–406
  36. O'Rourke MF, Hashimoto J. Arterial stiffness: a modifiable cardiovascular risk factor?. J Cardiopulm Rehabil Prev. 2008;28:225–237
  37. Nilsson PM, Lurbe E, Laurent S. The early life origins of vascular ageing and cardiovascular risk: the EVA syndrome. J Hypertens. 2008;26:1049–1057
  38. Abhayaratna WP, Barnes ME, O'Rourke MF, Gersh BJ, Seward JB, Miyasaka Y, et al. Relation of arterial stiffness to left ventricular diastolic function and cardiovascular risk prediction in patients > or =65 years of age. Am J Cardiol. 2006;98:1387–1392
  39. Ikonomidis I, Tzortzis S, Papaioannou T, Protogerou A, Stamatelopoulos K, Papamichael C, et al. Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension. J Hum Hypertens. 2008;22:687–698
  40. Antonini-Canterin F, Carerj S, Di Bello V, Di Salvo G, La Carrubba S, Vriz O, et al. Arterial stiffness and ventricular stiffness: a couple of diseases or a coupling disease? A review from the cardiologist's point of view. Eur J Echocardiogr. 2009;10:36–43
  41. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107:2920–2925
  42. Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Risks for atrial fibrillation and congestive heart failure in patients >/=65 years of age with abnormal left ventricular diastolic relaxation. Am J Cardiol. 2004;93:54–58
  43. Redfield M, Jacobsen S, Burnett JJ, Mahoney D, Bailey KR, Rodeheffer R. Burden of systolic and diastolic ventricular dysfunction in the community. Appreciating the scope of the heart failure epidemic. JAMA. 2003;289:194–202
  44. Aurigemma GP, Gottdiener JS, Shemanski L, Gardin J, Kitzman D. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol. 2001;37:1042–1048
  45. Al-Omari M, Barnes M, Fatema K, Casaclang-Verzosa G, Cha S, Bailey K, et al. Combining E/e′ and indexed left atrial volume augments clinical prediction of first heart failure in elderly. Circulation. 2008;118S:841
  46. Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994;89:724–736
  47. Tsang TS, Barnes ME, Bailey KR, Leibson CL, Montgomery SC, Takemoto Y, et al. Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc. 2001;76:467–475
  48. Benjamin E, D'Agostino R, Belanger A, Wolf P, Levy D. Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation. 1995;92:835–841
  49. Barnes ME, Miyasaka Y, Seward JB, Gersh BJ, Rosales AG, Bailey KR, et al. Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation. Mayo Clin Proc. 2004;79:1008–1014
  50. Fatema K, Bailey KR, Petty GW, Meissner I, Osranek M, Alsaileek AA, et al. Increased left atrial volume index: potent biomarker for first-ever ischemic stroke. Mayo Clin Proc. 2008;83:1107–1115
  51. Takemoto Y, Barnes ME, Seward JB, Lester SJ, Appleton CA, Gersh BJ, et al. Usefulness of left atrial volume in predicting first congestive heart failure in patients > or = 65 years of age with well-preserved left ventricular systolic function. Am J Cardiol. 2005;96:832–836
  52. Gottdiener JS, Kitzman DW, Aurigemma GP, Arnold AM, Manolio TA. Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons > or =65 years of age (the cardiovascular health study). Am J Cardiol. 2006;97:83–89
  53. Moller JE, Hillis GS, Oh JK, Seward JB, Reeder GS, Wright RS, et al. Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation. 2003;107:2207–2212
  54. Beinart R, Boyko V, Schwammenthal E, Kuperstein R, Sagie A, Hod H, et al. Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol. 2004;44:327–334
  55. Rossi A, Cicoira M, Zanolla L, Sandrini R, Golia G, Zardini P, et al. Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy. J Am Coll Cardiol. 2002;40:1425
  56. Losi MA, Betocchi S, Barbati G, Parisi V, Tocchetti CG, Pastore F, et al. Prognostic significance of left atrial volume dilatation in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr. 2009;22:76–81
  57. Pritchett AM, Mahoney DW, Jacobsen SJ, Rodeheffer RJ, Karon BL, Redfield MM. Diastolic dysfunction and left atrial volume: a population-based study. J Am Coll Cardiol. 2005;45:87–92
  58. Tsang TS, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?. J Am Coll Cardiol. 2006;47:1018–1023
  59. Lester SJ, Ryan EW, Schiller NB, Foster E. Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol. 1999;84:829–832
  60. Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol. 2002;90:1284–1289
  61. Jais P, Shah DC, Hocini M, Yamane T, Haissaguerre M, Clementy J. Radiofrequency catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2000;11:758–761
  62. Anwar AM, Soliman OI, Geleijnse ML, Nemes A, Vletter WB, ten Cate FJ. Assessment of left atrial volume and function by real-time three-dimensional echocardiography. Int J Cardiol. 2008;123:155–161
  63. Blondheim DS, Osipov A, Meisel SR, Frimerman A, Shochat M, Shotan A. Relation of left atrial size to function as determined by transesophageal echocardiography. Am J Cardiol. 2005;96:457–463
  64. Karayannis G, Kitsios G, Kotidis H, Triposkiadis F. Left atrial remodelling contributes to the progression of asymptomatic left ventricular systolic dysfunction to chronic symptomatic heart failure. Heart Fail Rev. 2008;13:91–98
  65. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. 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. J Am Soc Echocardiogr. 2005;18:1440–1463
  66. Ujino K, Barnes ME, Cha SS, Langins AP, Bailey KR, Seward JB, et al. Two-dimensional echocardiographic methods for assessment of left atrial volume. Am J Cardiol. 2006;98:1185–1188
  67. Triposkiadis F, Tentolouris K, Androulakis A, Trikas A, Toutouzas K, Kyriakidis M, et al. Left atrial mechanical function in the healthy elderly: new insights from a combined assessment of changes in atrial volume and transmitral flow velocity. J Am Soc Echocardiogr. 1995;8:801–809
  68. Schiller NB, Botvinick EH. Noninvasive quantitation of the left heart by echocardiography and scintigraphy. Cardiovasc Clin. 1986;17:45–93
  69. Hofstetter R, Bartz-Bazzanella P, Kentrup H, von Bernuth G. Determination of left atrial area and volume by cross-sectional echocardiography in healthy infants and children. Am J Cardiol. 1991;68:1073–1078
  70. Vandenberg BF, Weiss RM, Kinzey J, Acker M, Stark CA, Stanford W, et al. Comparison of left atrial volume by two-dimensional echocardiography and cine-computed tomography. Am J Cardiol. 1995;75:754–757
  71. Schabelman S, Schiller NB, Silverman NH, Ports TA. Left atrial volume estimation by two-dimensional echocardiography. Cathet Cardiovasc Diagn. 1981;7:165–178
  72. Rodevan O, Bjornerheim R, Ljosland M, Maehle J, Smith HJ, Ihlen H. Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Card Imaging. 1999;15:397–410
  73. Khankirawatana B, Khankirawatana S, Porter T. How should left atrial size be reported? Comparative assessment with use of multiple echocardiographic methods. Am Heart J. 2004;147:369–374
  74. Keller AM, Gopal AS, King DL. Left and right atrial volume by freehand three-dimensional echocardiography: in vivo validation using magnetic resonance imaging. Eur J Echocardiogr. 2000;1:55–65
  75. Gutman J, Wang Y, Wahr D, Schiller N. Normal left atrial function determined by 2-dimensional echocardiography. Am J Cardiol. 1983;51:336–340
  76. Schiller N, Foster E. Analysis of left ventricular systolic function. Heart. 1996;75:17–26
  77. Thomas L, Levett K, Boyd A, Leung DY, Schiller NB, Ross DL. Compensatory changes in atrial volumes with normal aging: is atrial enlargement inevitable?. J Am Coll Cardiol. 2002;40:1630–1635
  78. Kurt M, Wang J, Torre-Amione G, Nagueh S. Left atrial function in diastolic heart failure. Circulation Cardiovasc Imaging. 2009;2:10–15
  79. Okamatsu K, Takeuchi M, Nakai H, Nishikage T, Salgo IS, Husson S, et al. Effects of aging on left atrial function assessed by two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr. 2009;22:70–75
  80. Matsuda Y, Toma Y, Moritani K, Ogawa H, Kohno M, Miura T, et al. Assessment of left atrial function in patients with hypertensive heart disease. Hypertension. 1986;8:779–785
  81. Abhayaratna WP, Fatema K, Barnes ME, Seward JB, Gersh BJ, Bailey KR, et al. Left atrial reservoir function as a potent marker for first atrial fibrillation or flutter in persons >/= 65 years of age. Am J Cardiol. 2008;101:1626–1629
  82. Tsang TS, Barnes M, Cha S, Bailey K, Seward J, Gersh BJ. Role of atrial function in first ischemic stroke: a prospective study. J Am Soc Echocardiogr. In press.
  83. Manning WJ, Leeman DE, Gotch PJ, Come PC. Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation. J Am Coll Cardiol. 1989;13:617–623
  84. Manning WJ, Silverman DI, Katz SE, Riley MF, Doherty RM, Munson JT, et al. Temporal dependence of the return of atrial mechanical function on the mode of cardioversion of atrial fibrillation to sinus rhythm. Am J Cardiol. 1995;75:624–626
  85. Manning WJ, Silverman DI, Katz SE, Riley MF, Come PC, Doherty RM, et al. Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation. J Am Coll Cardiol. 1994;23:1535–1540
  86. Bukachi F, Waldenstrom A, Morner S, Lindqvist P, Henein MY, Kazzam E. Pulmonary venous flow reversal and its relationship to atrial mechanical function in normal subjects—Umea General Population Heart Study. Eur J Echocardiogr. 2005;6:107–116
  87. Xie GY, Berk MR, Fiedler AJ, Sapin PM, Smith MD. Left atrial function in congestive heart failure: assessment by transmitral and pulmonary vein Doppler. Int J Card Imaging. 1998;14:47–53
  88. Thomas L, Levett K, Boyd A, Leung DY, Schiller NB, Ross DL. Changes in regional left atrial function with aging: evaluation by Doppler tissue imaging. Eur J Echocardiogr. 2003;4:92–100
  89. Wang M, Yip GW, Wang AY, Zhang Y, Ho PY, Tse MK, et al. Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol. 2003;41:820–826
  90. Zhang Q, Yip GW, Yu CM. Approaching regional left atrial function by tissue Doppler velocity and strain imaging. Europace. 2008;10(suppl):iii62-9
  91. Schneider C, Malisius R, Krause K, Lampe F, Bahlmann E, Boczor S, et al. Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J. 2008;29:1397–1409
  92. Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP. Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr. 2009;22:299–305
  93. Sirbu C, Herbots L, D'Hooge J, Claus P, Marciniak A, Langeland T, et al. Feasibility of strain and strain rate imaging for the assessment of regional left atrial deformation: a study in normal subjects. Eur J Echocardiogr. 2006;7:199–208
  94. Thomas L, McKay T, Byth K, Marwick TH. Abnormalities of left atrial function after cardioversion: an atrial strain rate study. Heart. 2007;93:89–95
  95. Tsang TS, Barnes ME, Abhayaratna WP, Cha SS, Gersh BJ, Langins AP, et al. Effects of quinapril on left atrial structural remodeling and arterial stiffness. Am J Cardiol. 2006;97:916–920
  96. Gerdts E, Wachtell K, Omvik P, Otterstad JE, Oikarinen L, Boman K, et al. Left atrial size and risk of major cardiovascular events during antihypertensive treatment: losartan intervention for endpoint reduction in hypertension trial. Hypertension. 2007;49:311–316
  97. Meris AAM, Uno H, Thune J, Verma A, Køber L, Bourgoun M, et al. Left atrial remodelling in patients with myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALIANT Echo study. Eur Heart J. 2009;30:56–65
  98. Tsang TS, Barnes ME, Gersh BJ, Takemoto Y, Rosales AG, Bailey KR, et al. Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography. J Am Coll Cardiol. 2003;42:1199–1205
  99. Wang TJ, Gona P, Larson MG, Tofler GH, Levy D, Newton-Cheh C, et al. Multiple biomarkers for the prediction of first major cardiovascular events and death. N Engl J Med. 2006;355:2631–2639
  100. Benjamin EJ, Chen PS, Bild DE, Mascette AM, Albert CM, Alonso A, et al. Prevention of atrial fibrillation: report from a national heart, lung, and blood institute workshop. Circulation. 2009;119:606–618

 Dr Tsang is supported by grant RO1 AG22070 from the National Institutes of Health (Bethesda, MD) and an Echo Investigator Award from the American Society of Echocardiography (Morrisville, NC).

PII: S0894-7317(09)00304-6

doi: 10.1016/j.echo.2009.03.023

Journal of the American Society of Echocardiography
Volume 22, Issue 6 , Pages 649-656 , June 2009