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Updated: May 2, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Three-dimensional analysis of the left atrial appendage for detecting paroxysmal atrial fibrillation in acute
Koji Tanaka1, Masatoshi Koga, Kazuaki Sato
1Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Insights
Left atrial appendage volume and ejection fraction measured by 3D transesophageal echocardiography can help detect paroxysmal atrial fibrillation in patients with stroke. This imaging technique shows promise for identifying patients at risk of cardioembolic events.
Area of Science:
- Cardiology
- Medical Imaging
- Neurology
Background:
- Atrial fibrillation (AF) impairs left atrial appendage (LAA) function, increasing thrombus formation and cardioembolic stroke risk.
- Accurate detection of AF, particularly paroxysmal AF, is crucial for stroke prevention.
Purpose of the Study:
- To evaluate the association between LAA volume, measured by real-time three-dimensional transesophageal echocardiography (3D-TEE), and the presence of paroxysmal AF.
- To assess the diagnostic performance of LAA volumetric parameters in patients with cerebral infarction or transient ischemic attack (TIA).
Main Methods:
- Real-time 3D-TEE was used to measure LAA end-diastolic volume (LAA-EDV), end-systolic volume (LAA-ESV), and ejection fraction (LAA-EF).
- Patients in normal sinus rhythm during examination were categorized based on the presence or absence of paroxysmal AF.
- Volumetric data were indexed to body surface area (BSA).
Main Results:
- Patients with paroxysmal AF exhibited significantly larger LAA-EDV (4.78 vs. 3.14 ml/m²) and LAA-ESV (3.10 vs. 1.39 ml/m²), and lower LAA-EF (37.3% vs. 57.1%) compared to those without paroxysmal AF (P<0.001 for all).
- Optimal cutoffs were identified for LAA-EF (47.9%), LAA-ESV (1.26 ml/m²), and LAA-EDV (4.52 ml/m²) for predicting paroxysmal AF.
- Multivariate analysis confirmed these LAA volumetric parameters were independent predictors of paroxysmal AF after adjusting for clinical factors.
Conclusions:
- LAA volumetric analysis using real-time 3D-TEE is a valuable tool for detecting paroxysmal AF.
- This imaging approach shows promise in identifying patients with acute cerebral infarction or TIA who may have underlying paroxysmal AF, aiding in stroke risk stratification.
Background:
Atrial fibrillation impairs left atrial appendage function and the thrombus formation in the left atrial appendage is a major cause of cardioembolic stroke.
Aims:
To evaluate the association between the volume of the left atrial appendage measured by real-time three-dimensional transesophageal echocardiography and presence of paroxysmal atrial fibrillation in patients with cerebral infarction or transient ischemic attack.
Methods:
Real-time three-dimensional transesophageal echocardiography was performed to measure left atrial appendage end-diastolic and end-systolic volumes to calculate left atrial appendage ejection fraction. Patients with normal sinus rhythm at the time of real-time three-dimensional transesophageal echocardiography were divided into groups with and without paroxysmal atrial fibrillation. Volumetric data were corrected with the body surface area.
Results:
Of 146 patients registered, 102 (29 women, 72·2 ± 10·7 years) were normal sinus rhythm at the examination. In 23 patients with paroxysmal atrial fibrillation, left atrial appendage end-diastolic volume (4·78 ± 3·00 ml/m(2) vs. 3·14 ± 2·04 ml/m(2), P = 0·003) and end-systolic volume (3·10 ± 2·47 ml/m(2) vs. 1·39 ± 1·56 ml/m(2), P < 0·001) were larger and left atrial appendage ejection fraction (37·3 ± 19·1% vs. 57·1 ± 17·5%, P < 0·001) was lower than in the other 79 patients without paroxysmal atrial fibrillation. The optimal cutoff for left atrial appendage peak flow velocity to predict paroxysmal atrial fibrillation was 39·0 cm/s (sensitivity, 54·6%; specificity, 89·7%; c-statistic, 0·762). The cutoffs for left atrial appendage end-diastolic volume, end-systolic volume, and ejection fraction were 4·52 ml/m(2) (sensitivity, 47·8%; specificity, 82·3%; c-statistic, 0·694), 1·26 ml/m(2) (sensitivity, 91·3%; specificity, 60·3%; c-statistic, 0·806), and 47·9% (sensitivity, 78·3%; specificity, 74·7%; c-statistic, 0·774), respectively. In multivariate analysis, all these parameters were independently associated with paroxysmal atrial fibrillation after adjusting for sex, age, diabetes mellitus, and previous stroke.
Conclusions:
Left atrial appendage volumetric analysis by real-time three-dimensional transesophageal echocardiography is a promising method for detecting paroxysmal atrial fibrillation in acute cerebral infarction or transient ischemic attack.
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