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Updated: Apr 27, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Multi-ethnic study of atherosclerosis: association between left atrial function using tissue tracking from cine MR
Masamichi Imai1, Bharath Ambale Venkatesh, Sanaz Samiei
1From the Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287-0409 (M.I., B.A.V., S.S., S.D., A.C.A., J.A.C.L.); Department of Cardiology, Johns Hopkins Hospital, Baltimore, Md (M.H.); Cardiovascular Health Research Unit, Washington University, St Louis, Mo (S.R.H.); and Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md (C.O.W., D.A.B.).
Insights
Reduced left atrial (LA) function is linked to myocardial fibrosis. Cardiac MRI revealed impaired LA volume, strain, and strain rate in patients with myocardial scar, indicating fibrosis affects atrial function.
Area of Science:
- Cardiology
- Medical Imaging
- Biophysics
Background:
- Left atrial (LA) function plays a crucial role in cardiovascular health.
- Myocardial fibrosis, characterized by scar tissue or diffuse infiltration, can impair cardiac function.
- Understanding the relationship between LA function and myocardial fibrosis is vital for diagnosing and managing heart conditions.
Purpose of the Study:
- To investigate the association between left atrial (LA) function and left ventricular myocardial fibrosis.
- To utilize cardiac magnetic resonance (MR) imaging in a multi-ethnic population to assess this relationship.
Main Methods:
- A multi-ethnic cohort study involving 143 participants with myocardial scar and 286 matched controls identified via cardiac MR.
- Analysis of LA volume, strain, and strain rate using multimodality tissue tracking from cine MR imaging.
- Assessment of diffuse myocardial fibrosis using T1 mapping, with associations evaluated by Student t test and multivariable regression.
Main Results:
- Participants with myocardial scar exhibited significantly lower LA volume, ejection fraction, maximal strain, and strain rates compared to controls.
- T1 mapping showed significant associations between diffuse fibrosis (T1 time) and various LA strain and strain rate parameters.
- These findings indicate a correlation between the presence of myocardial fibrosis and impaired LA function.
Conclusions:
- Reduced regional and global LA function are associated with both replacement (scar) and diffuse myocardial fibrosis.
- Cardiac MR imaging, including T1 mapping, is a valuable tool for assessing these relationships.
- The study highlights the interconnectedness of atrial function and ventricular myocardial health.
Purpose:
To investigate the association between left atrial ( LA left atrium ) function and left ventricular myocardial fibrosis using cardiac magnetic resonance (MR) imaging in a multi-ethnic population.
Materials And Methods:
For this HIPAA-compliant study, the institutional review board at each participating center approved the study protocol, and all participants provided informed consent. Of 2839 participants who had undergone cardiac MR in 2010-2012, 143 participants with myocardial scar determined with late gadolinium enhancement and 286 age-, sex-, and ethnicity-matched control participants were identified. LA left atrium volume, strain, and strain rate were analyzed by using multimodality tissue tracking from cine MR imaging. T1 mapping was applied to assess diffuse myocardial fibrosis. The association between LA left atrium parameters and myocardial fibrosis was evaluated with the Student t test and multivariable regression analysis.
Results:
The scar group had significantly higher minimum LA left atrium volume than the control group (mean, 22.0 ± 10.5 [standard deviation] vs 19.0 ± 7.8, P = .002) and lower LA left atrium ejection fraction (45.9 ± 10.7 vs 51.3 ± 8.7, P < .001), maximal LA left atrium strain ( Smax maximum LA strain ) (25.4 ± 10.7 vs 30.6 ± 10.6, P < .001) and maximum LA left atrium strain rate ( SRmax maximum LA strain rate ) (1.08 ± 0.45 vs 1.29 ± 0.51, P < .001), and lower absolute LA left atrium strain rate at early diastolic peak ( SRE LA strain rate at early diastolic peak ) (-0.77 ± 0.42 vs -1.01 ± 0.48, P < .001) and LA left atrium strain rate at atrial contraction peak ( SRA LA strain rate at atrial contraction peak ) (-1.50 ± 0.62 vs -1.78 ± 0.69, P < .001) than the control group. T1 time 12 minutes after contrast material injection was significantly associated with Smax maximum LA strain (β coefficient = 0.043, P = .013), SRmax maximum LA strain rate (β coefficient = 0.0025, P = .001), SRE LA strain rate at early diastolic peak (β coefficient = -0.0016, P = .027), and SRA LA strain rate at atrial contraction peak LA strain rate at atrial contraction peak (β coefficient -0.0028, P = .01) in the regression model. T1 time 25 minutes after contrast material injection was significantly associated with SRmax maximum LA strain rate (β coefficient = 0.0019, P = .016) and SRA LA strain rate at atrial contraction peak (β coefficient = -0.0022, P = .034).
Conclusion:
Reduced LA left atrium regional and global function are related to both replacement and diffuse myocardial fibrosis processes. Clinical trial registration no.: NCT00005487
