Standardised computed tomographic assessment of left atrial morphology and tissue thickness in humans

Whitaker, John; Karády, Júlia; Karim, Rashed; Tobon-Gómez, Catalina; Fastl, Thomas; Razeghi, Orod; O’Neill, Louisa; Decroocq, Marie; Williams, Steven E.; Corrado, Cesare; Mukherjee, Rahul; Sim, Iain; O’Hare, Daniel; Kotadia, Irum; Kolossváry, Márton; Merkely, Béla; Littvay, Levente; Tárnoki, Ádám Domonkos; Tárnoki, Dávid László; Vörös, Szilárd; Razavi, Reza; O’Neill, Mark; Rajani, Ronak; Maurovich-Horvat, Pál; Niederer, Steven

doi:10.1016/j.ijcha.2020.100694

Cited by 5 publications

(7 citation statements)

References 40 publications

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“…Decreased LA-LV angulation may be a new additional measure of LA remodeling [ 9 , 18 , 19 ], beyond LAVol, in patients with mitral regurgitation and LV enlargement and dysfunction, and relate LA to LV remodeling [ 12 ]. Unlike LAVol, LA–LV angulation was not associated with the participants’ age, sex, or BSA, although both measures related to LVEDV [ 20 ], contrary to LA sphericity, LA–LV angulation was not associated with 3D LA volume or the patients sex [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Left atrial-left ventricular angle, a new measure of left atrial and left ventricular remodeling

Al-Mohaissen

Chow

Lee

et al. 2021

Int J Cardiovasc Imaging

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We assessed the left atrial-left ventricular (LA-LV) long axis angulation value as a new measure of LA remodeling, and studied its predictors, its effect on two-dimensional LA volume (2D LAVol) estimation, and optimization techniques for 2D LAVol values. Retrospective electrocardiogram-gated coronary computed tomographic angiograms of 164 consecutive patients were reviewed. The LA–LV angle was measured in reconstructed 3-chamber views, and its predictors were determined. The LAVol measured by the area-length method after image optimization along the LV long axis (AL) and the LA long axis (AC–AL), was compared with that measured by the three-dimensional (3D)-volumetric method. LAVol calculation was modified to minimize differences from the 3D values. LA–LV angles ranged from 0° to 63°. In the univariate analysis, decreasing angulation was significantly associated with increasing LV end-diastolic volume (LVEDV), mitral regurgitation grade, LV and LA anteroposterior dimensions, and decreasing LV ejection fraction (LVEF). On multivariate analysis, increasing LVEDV, MR, and LA anteroposterior dimension inversely correlated with angulation; LVEF was positively correlated. The AL and 3D methods significantly differed only for patients with angles ≤ 29.9°. Conversely, LAVol was overestimated for all angules by AC–AL. Modification of AL LAVol using a regression equation, or by substituting the shortest with the longest and average LA lengths in patients with angles ≤ 29.9° and 30–39.9°, respectively neutralized the difference. The LA–LV angle is a new measure of LA and LV remodeling predicted by LV size and function, MR, and LA-anteroposterior dimension. AL formula modifications based on angulation in LV-optimized views better correlate with the 3D method than LA-view modification.

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Section: Discussionmentioning

confidence: 99%

Left atrial-left ventricular angle, a new measure of left atrial and left ventricular remodeling

Al-Mohaissen

Chow

Lee

et al. 2021

Int J Cardiovasc Imaging

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“…15 The completeness of the roof line had the higher failure rate, probably because the wall thickness in this area is greater than in the inferior part of the left atrium or the antral region of the PVs. 16 The epicardial connections of the right atrium with the PW are well-defined anatomical The circumferential catheter is in contact with the posterior wall, and the pulmonary veins are already isolated.…”

Section: Interventional and Long-term Outcomesmentioning

confidence: 99%

Box Lesion Isolation of the Left Atrial Posterior Wall with Radiofrequency Ablation Restricted in Predetermined Lines for the Treatment of Persistent Atrial Fibrillation: The Prognostic Role of Acute Interventional Outcome and Trigger Identification

IOANNIDIS,

KATSARAS,

ZOGRAFOS

et al. 2023

J Innov Cardiac Rhythm Manage.

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The left atrial posterior wall (PW) is known to be a critical substrate for the initiation and perpetuation of atrial fibrillation (AF) and has been explored as a target for catheter ablation, particularly in persistent AF (PerAF). In this retrospective study, we investigate the clinical outcome of patients with PerAF who underwent PW isolation (PWI) restricted in predetermined lines in addition to pulmonary vein isolation (PVI). One hundred consecutive patients (64 ± 9.1 years, 66% male, 20% with previous PVI ablation) underwent PWI in a box lesion setting for PerAF lasting >3 months (34% long-standing PerAF). PW triggers were defined as either foci from the PW that repeatedly induced AF or as isolated AF or atrial tachycardia (AT) within the PW. After a mean follow-up period of 25.6 ± 6.7 months, 61% of the patients remained in sinus rhythm after the last procedure. In 79 patients, the PW was successfully isolated, while, in 21 patients, complete isolation was not possible due to failure in completion of the roof line (n = 16), the floor line (n = 7), or both (n = 2). Patients with incomplete isolation had similar AF/AT recurrence rates compared to those with complete PWI. In 12 patients, PW triggers were identified, and PWI in these patients was shown to have a significantly better prognosis in terms of sinus rhythm maintenance (P = .031). Failure of complete PWI does not predispose a patient to an inferior outcome nor is it responsible for iatrogenic ATs. The presence of AF triggers within the PW leads to a particularly favorable result after box lesion isolation.

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“…However, this image resolution challenge may be less of an issue in infiltrative cardiomyopathies given increased wall thickness. 30,31 Positron emission /computed tomography imaging with its enhanced spatial resolution (4-6 mm) or perhaps the advent of more selective tracers may respectively improve our diagnostic sensitivity to detect AU.…”

Section: Limitationsmentioning

confidence: 99%

Association Between Atrial Uptake on Cardiac Scintigraphy With Technetium-99m-Pyrophosphate Labeled Bone-Seeking Tracers and Atrial Fibrillation

Hussain

Krywanczyk

Donnellan

et al. 2022

Circ: Cardiovascular Imaging

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Background: Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized disease, in which atrial fibrillation (AF) has been shown to be prevalent. Cardiac scintigraphy with technetium-99m-pyrophosphate (99mTc-PyP) labeled bone-seeking tracers is used to noninvasively make the diagnosis of ATTR-CA, based on ventricular myocardial uptake. Assessment of atrial wall uptake (AU) on 99mTc-PyP is currently not used in the clinical setting Methods: We analyzed a cohort of patients referred for 99mTc-PyP scan at a tertiary center to explore AU and associations between any and incident AF, ATTR-CA, and all-cause mortality. Results: Among 580 patients included, 296 patients (51%) had a diagnosis of AF; 164 patients (28%) had scans consistent with ATTR-CA while 117 patients (20%) had AU. Of 117 patients with AU, 107 (91%) had any AF. In contrast, of 463 patients without AU 191(41%) had any AF. Of those with AU, 59/117(50%) patients had a 99mTc-PyP diagnosis of ATTR-CA while 58/117(50%) patients did not have such a diagnosis ( P =1.00). Patients with AU had significantly more any AF (hazard ratio [HR], 1.03 [95% CI, 1.02–1.04]; P <0.001), independent of ATTR-CA diagnosis and sex. On multivariable Cox proportional hazards analyses adjusting for age, AU, ATTR-CA diagnosis, sex, smoking, hypertension, diabetes, left ventricular ejection fraction, and coronary artery disease, both age (HR, 1.03 [95% CI, 1.02–1.04]; P <0.0001) and AU (HR, 2.68 [95% CI, 2.11–3.41]; P <0.0001) were independently associated with the development of any AF. Freedom from incident AF at 1-year was significantly lower in patients with AU, both in patients with and without ATTR-CA respectively (HR, 2.27 [95% CI, 1.37–3.78]; P <0.0001 versus HR, 2.21 [95% CI, 1.46–3.34]; P <0.0001). Conclusions: In a consecutive cohort of patients undergoing 99mTc-PyP scans, 20% had AU, which was statistically associated with any AF, independently of ATTR-CA diagnosis and sex. AU was associated with significantly lower freedom from incident AF at 1-year. Overlooking AU on 99mTc-PyP scans could potentially miss an earlier disease manifestation, or an additional risk factor for any/incident AF.

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Standardised computed tomographic assessment of left atrial morphology and tissue thickness in humans

Cited by 5 publications

References 40 publications

Left atrial-left ventricular angle, a new measure of left atrial and left ventricular remodeling

Left atrial-left ventricular angle, a new measure of left atrial and left ventricular remodeling

Box Lesion Isolation of the Left Atrial Posterior Wall with Radiofrequency Ablation Restricted in Predetermined Lines for the Treatment of Persistent Atrial Fibrillation: The Prognostic Role of Acute Interventional Outcome and Trigger Identification

Association Between Atrial Uptake on Cardiac Scintigraphy With Technetium-99m-Pyrophosphate Labeled Bone-Seeking Tracers and Atrial Fibrillation

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