Clinical Conditions And Cardiac Function: Correlations With Left Atrial Fibrosis By Mri In Subjects With And Without Atrial Fibrillation

The purpose of this study was to evaluate the clinical conditions and cardiac functions associated with left atrial (LA) fibrosis by late gadolinium enhancement (LGE). LA LGE has been found to be associated with various measures of cardiac functions, procedural outcomes, and adverse events in patients who already have atrial fibrillation (AF). Assessment of LA fibrosis by LGE in patients without AF has largely been unexamined and comparison of these patients to those with AF could prove useful. This study was a retrospective chart and imaging review of 137 consecutive subjects imaged with a 3D LGE sequence at one institution from 2012-2014. Fibrosis by LA LGE is elevated in subjects with congestive heart failure (CHF), AF, hypertrophic cardiomyopathy (HCM), and mitral regurgitation when compared to a set of reference subjects (all p \u3c 0.05). In multivariate analysis, HCM (p = 0.01) and CHF (p \u3c 0.01) were independently associated with elevated LGE. Across all subjects, LA LGE was moderately correlated with minimum LA volume (r = 0.41, p \u3c 0.01) and LA ejection fraction (r = -0.43, p \u3c 0.01) but weakly correlated with maximum LA volume (r = 0.197, p = 0.02); these relationships were similar in subgroups with and without AF. In a subset of subjects without AF, there was a lower active atrial ejection fraction with increasing LA LGE (r = -0.438, p \u3c 0.01). Also, after multivariate adjustment for ventricular filling measures, there was an independent association of increased LA LGE with decreased passive LA emptying (p = 0.02). Subjects with heart failure but ventricular ejection fraction \u3e45% had greater LA LGE than those with whose ejection fraction was We found that extent of LGE correlates with the presence of CHF, AF, HCM, mitral regurgitation, and some cardiac anatomic and functional measurements. This study lays the groundwork for further evaluation of the utility of measuring LA LGE in patients without AF

Assessment of diastolic function and atrial remodeling by MRI – validation and correlation with echocardiography and filling pressure

Atrial fibrosis can be estimated noninvasively by magnetic resonance imaging (MRI) using late gadolinium enhancement (LGE), but diastolic dysfunction is clinically assessed by transthoracic echocardiography (TTE), and rarely by MRI. This study aimed to evaluate well-established diastolic parameters using MRI, and validate them with TTE and left ventricular (LV) filling pressures, and to study the relationship between left atrial (LA) remodeling and parameters of diastolic function. The study retrospectively included 105 patients (53 ± 16 years, 39 females) who underwent 3D LGE MRI between 2012 and 2016. Medical charts were reviewed for the echocardiographic diastolic parameters E, A, and e′ by TTE, and pressure catheterizations. E and A were measured from in-plane phase-contrast cardiac MRI images, and e′ by feature-tracking, and validated with TTE. Interobserver and intraobserver variability was examined. Furthermore, LA volumes, function, and atrial LGE was correlated with diastolic parameters. Evaluation of e′ in MRI had strong agreement with TTE (r = 0.75, P < 0.0001), and low interobserver and intraobserver variability. E and A by TTE showed strong agreement to MRI (r = 0.77, P = 0.001; r = 0.73, P = 0.003, for E and A, respectively). Agreement between E/e′ by TTE and MRI was strong (r = 0.85, P = 0.0004), and E/e′ by TTE correlated moderately to invasive pressures (r = 0.59, P = 0.03). There was a strong relationship between LA LGE and pulmonary capillary wedge pressure (r = 0.81, P = 0.01). In conclusion, diastolic parameters can be measured with good reproducibility by cardiovascular MRI. LA LGE exhibited a strong relationship with pulmonary capillary wedge pressure, an indicator of diastolic function

Prognostic and functional implications of left atrial late gadolinium enhancement cardiovascular magnetic resonance

Abstract Background Left atrial (LA) late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging is indicative of fibrosis, and has been correlated with reduced LA function, increased LA volume, and poor procedural outcomes in cohorts with atrial fibrillation (AF). However, the role of LGE as a prognostic biomarker for arrhythmia in cardiac disease has not been examined. Methods In this study, we assessed LA LGE using a 3D LGE CMR sequence to examine its relationships with new onset atrial arrhythmia, and LA and left ventricular (LV) mechanical function. Results LA LGE images were acquired in 111 patients undergoing CMR imaging, including 66 patients with no prior history of an atrial arrhythmia. During the median follow-up of 2.7 years (interquartile range (IQR) 1.8–3.7 years), 15/66 (23%) of patients developed a new atrial arrhythmia. LA LGE ≥10% of LA myocardial volume was significantly associated with an increased rate of new-onset atrial arrhythmia, with a hazard ratio of 3.16 (95% CI 1.14–8.72), p = 0.026. There were significant relationships between LA LGE and both LA ejection fraction (r = − 0.39, p < 0.0005) and echocardiographic LV septal e’ (r = − 0.24, p = 0.04) and septal E/e’ (r = 0.31, p = 0.007). Conclusions Elevated LA LGE is associated with reduced LA function and reduced LV diastolic function. LA LGE is associated with new onset atrial arrhythmia during follow-up

Assessment of diastolic function and atrial remodeling by MRI – validation and correlation with echocardiography and filling pressure

Atrial fibrosis can be estimated noninvasively by magnetic resonance imaging (MRI) using late gadolinium enhancement (LGE), but diastolic dysfunction is clinically assessed by transthoracic echocardiography (TTE), and rarely by MRI. This study aimed to evaluate well-established diastolic parameters using MRI, and validate them with TTE and left ventricular (LV) filling pressures, and to study the relationship between left atrial (LA) remodeling and parameters of diastolic function. The study retrospectively included 105 patients (53 ± 16 years, 39 females) who underwent 3D LGE MRI between 2012 and 2016. Medical charts were reviewed for the echocardiographic diastolic parameters E, A, and e′ by TTE, and pressure catheterizations. E and A were measured from in-plane phase-contrast cardiac MRI images, and e′ by feature-tracking, and validated with TTE. Interobserver and intraobserver variability was examined. Furthermore, LA volumes, function, and atrial LGE was correlated with diastolic parameters. Evaluation of e′ in MRI had strong agreement with TTE (r = 0.75, P < 0.0001), and low interobserver and intraobserver variability. E and A by TTE showed strong agreement to MRI (r = 0.77, P = 0.001; r = 0.73, P = 0.003, for E and A, respectively). Agreement between E/e′ by TTE and MRI was strong (r = 0.85, P = 0.0004), and E/e′ by TTE correlated moderately to invasive pressures (r = 0.59, P = 0.03). There was a strong relationship between LA LGE and pulmonary capillary wedge pressure (r = 0.81, P = 0.01). In conclusion, diastolic parameters can be measured with good reproducibility by cardiovascular MRI. LA LGE exhibited a strong relationship with pulmonary capillary wedge pressure, an indicator of diastolic function