The use of MRI in quantification of the atrial fibrosis in patients with rheumatic mitral disease

Abstract

Background Atrial fibrillation (AF) is a common type of arrhythmia with higher incidence in countries with increased prevalence of rheumatic heart disease (RHD), where AF contributes to significant morbidity and mortality in young population. Atrial fibrosis is a common feature of AF. Delayed enhancement MRI (DE-MRI) is a well-established method for characterizing fibrosis in ventricles. The use of DE-MRI to detect left atrial fibrosis helps to evaluate the extent of atrial structural remodeling non-invasively. The aim of this study is to evaluate the atrial fibrosis in patients with mitral valve disease, using the DE MRI, regarding its amount, distribution, and relation to AF. Results Patients with AF were older and have longer duration of symptoms, smaller valve area, larger LA size, and more fibrosis at the left atrium (with the posterior wall most frequently involved) in comparison to those with sinus rhythm. Patients with atrial fibrosis were older and have longer duration of symptoms, smaller valve area, and larger LA, and most of them had AF compared to those without fibrosis. The comparison between types of AF showed a significant difference in the amount of atrial fibrosis that increases across the spectrum of AF. Conclusion In patients with rheumatic mitral valve diseases, AF is associated with more atrial fibrosis as assessed by DE-MRI. Atrial fibrosis is the best independent predictor of AF.

Delayed-enhancement cardiac magnetic resonance imaging detects disease progression in patients with mitral valve disease and atrial fibrillation

“… 32 , 33 In the last few decades, the use of DE-MRI has been expanded to quantify LA fibrosis in nonvalvular AF and has been used to associate both pre- and postcatheter ablation fibrotic scarring to arrhythmia recurrence. 16 , 17 , 18 , 34 , 35 Furthermore, even fewer studies have used DE-MRI to assess LA fibrosis in valvular AF. 35 Identifying these fibrotic patterns using DE-MRI would be valuable in further defining the impact of both MV disease and AF on the degree and distribution of atrial fibrosis.…”

Clinical and Echocardiographic Predictor of Atrial Fibrillation in Patient with Rheumatic Mitral Valve Disease

“…Ismail et al [14] revealed that AF cases were older and have extended period of signs, slighter valve area, greater LA size, and further fibrosis, including the left atrium more than the right one with the backward left atrial barrier commonest included. Between the atrial walls investigated (septal, frontal and backward LA, and RA walls), the backward LA wall is the commonest influenced location in all cases (56.6%) and in sinus as well as AF subgroups (26.7% and 86.7%, respectively).…”

“…Fuenmayor et al [19] confirmed that IACT was invasively determined by electrode catheter, associated with IACT determined via transthoracic echo-cardiography as the period from the start of the P-wave to the start of the mitral A-wave. Furthermore, Ismail et al [14] revealed that the amount of atrial fibrosis trailed by LA size was the most significant prognosticator of AF. LA size was larger in cases with AF than those in sinus rhythm and the LA size significantly varies across the AF spectrum.…”

Left atrial booster-pump function as a predictive parameter for atrial fibrillation in patients with severely dilated left atrium

“…There is also increasing evidence of microRNAs involvement in the pathogenesis of AF based on their link to fibrotic and apoptotic pathways (36). Atrial myopathy results from the development of fibrosis (7), which causes atrial dysfunction and localized regions of conduction slowing, thereby increasing AF susceptibility (37) (41), which is the best independent predictor of AF and seems to be a cause rather than an effect (42). These could explain why our data showed a higher prevalence of sick sinus syndrome and RHD in the AF groups than in the no-AF group.…”