Left atrial minimum volume is more strongly associated with N-terminal pro-B-type natriuretic peptide than the left atrial maximum volume in a community-based sample

Int J Cardiovasc Imaging. 2016 Mar;32(3):417-25. doi: 10.1007/s10554-015-0800-1. Epub 2015 Oct 26.


Previous data have demonstrated that left atrial (LA) minimum volume indexed for body surface area (LAVImin) is more strongly associated with the Doppler echocardiographic E/e' ratio than LA maximum volume index (LAVImax). We sought to explore if LAVImin was more closely related to serum levels of NT-proBNP than LAVImax and E/e' in the community. A community-based sample of 730 subjects underwent echocardiographic examinations and NT-proBNP measurements. The mean age of the participants was 66.3 years (range 38-86) and 72% were men. Age (Spearman correlation [rho] 0.533), LAVImin (rho 0.460), LAVImax (rho 0.360), estimated glomerular filtration rate (rho -0.349), and E/e' (rho 0.301; all P < 0.001) were strongly correlated with log-NT-proBNP. In a multiple linear regression model with log-NT-proBNP as dependent variable and LAVImin, LAVImax, E/e' ratio, and potential confounders as predictors, an adjusted R(2) of 44.9% was obtained. When excluding either of LAVImin (R(2) 42.6%, P < 0.001) or E/e' (R(2) 44.6%, P = 0.019) the model fit was significantly reduced. In contrast, when LAVImax was excluded the model fit was preserved (R(2) 45.0%, P = 0.69). To detect an NT-proBNP level of >125 ng/L, LAVImin yielded a significantly larger area under the receiver operating characteristic curve (AUC) of 0.749 than LAVImax (AUC 0.701; P < 0.001) and E/e' (AUC 0.661; P < 0.001). In our community-based sample, LAVImin was more strongly associated with NT-proBNP than LAVImax. Moreover, the discriminatory power to detect an elevated NT-proBNP level was stronger in LAVImin than in LAVImax and E/e'. Our findings support previous data that LAVImin may be more closely related to LV filling function than LAVImax.

Keywords: Doppler echocardiography; General population; Left atrial volumes; NT-proBNP.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Atrial Function, Left*
  • Biomarkers / blood
  • Echocardiography, Doppler
  • Female
  • Heart Atria / diagnostic imaging
  • Heart Atria / physiopathology
  • Heart Diseases / blood
  • Heart Diseases / diagnosis*
  • Heart Diseases / diagnostic imaging
  • Heart Diseases / physiopathology
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Predictive Value of Tests
  • ROC Curve
  • Up-Regulation
  • Ventricular Function, Left


  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain