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

Abstract

BackgroundLeft 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.MethodsIn 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.ResultsLA 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).ConclusionsElevated 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.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0514-3) contains supplementary material, which is available to authorized users.

Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

“…The ZAQ score of 2 points accurately identified the presence and the extent of LVZs (area under the curve [AUC], 0.809; 95% confidence interval [CI], 0.758-0.861; P < .001 and 3 [interquartile range, IQR, 1.5-4.5] vs 7 cm 2 [IQR 4-9]; P = .001). In a validation cohort of 103 patients, the predictive value of the score was confirmed (AUC, 0.793; 95% CI, 0.709-0.878; P < .001 and 4 [IQR, 2-7] vs 11.5 cm 2 [IQR,[8][9][10][11][12][13][14][15][16].5]; P = .001).…”

“…Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) 8,9 and electroanatomic voltage map (EAVM) 10 have been used for substrate characterization. The former is difficult to quantify using standard MRI software.…”

“…4,5 Substrate modification using catheter techniques has received renewed interest, and additional targeted ablation of low-voltage zones (LVZs) has yielded favorable results. 6,7 Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) 8,9 and electroanatomic voltage map (EAVM) 10 have been used for substrate characterization. The former is difficult to quantify using standard MRI software.…”

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

“…Coronary microvascular dysfunction is exceptionally common in HFpEF and, when present, is associated with a two‐fold increase in the prevalence of AF . Cardiac magnetic resonance imaging (MRI) reveals meaningful myocardial fibrosis (in the LA and LV) in both patients with HFpEF and those with AF . Fibrosis is indicative of an underlying atrial and ventricular myopathy and may precede the clinical identification of AF or HFpEF …”

“…37,38 Fibrosis is indicative of an underlying atrial and ventricular myopathy and may precede the clinical identification of AF or HFpEF. 32,39,40…”