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Published on: July 20, 2022
Quantification of left atrial volume and phasic function using cardiovascular magnetic resonance imaging-comparison
Laura Kristin Wandelt1,2, Johannes Tammo Kowallick3,4, Andreas Schuster4,5
1Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany. laura.wandelt@stud.uni-goettingen.de.
Insights
The biplane area-length method (Bi-ALM) underestimates left atrial volume and overestimates function compared to Simpson's method in cardiovascular magnetic resonance imaging. Simpson's method offers more accurate left atrial quantification for improved patient outcomes.
Area of Science:
- Cardiovascular Imaging
- Cardiac MRI
- Left Atrial Function
Background:
- Left atrial (LA) enlargement and dysfunction are key indicators of diastolic dysfunction and predict cardiovascular events.
- Accurate quantification of LA volume (LAV) and function is crucial for risk stratification.
- The biplane area-length method (Bi-ALM) is commonly used in cardiovascular magnetic resonance (CMR) due to its speed.
Purpose of the Study:
- To compare the diagnostic accuracy of the Bi-ALM with Simpson's method for quantifying LA volume and function.
- To evaluate the reliability and reproducibility of both methods in patients post-cerebral ischemia.
Main Methods:
- 31 patients with recent cerebral ischemia underwent 3T CMR, including cine SSFP sequences in transversal orientation.
- Left atrial volume (LAV) and emptying fractions (Total, Passive, Active) were calculated using both Bi-ALM and Simpson's method.
- Intra- and inter-observer variability was assessed for both methods.
Main Results:
- Significant differences were observed in LA volume and function between Bi-ALM and Simpson's method.
- Bi-ALM underestimated LAV (e.g., LAVmax: 80.18 vs. 98.80 ml) and overestimated LA function (e.g., LAEF Total: 55.17% vs. 47.85%).
- Simpson's method demonstrated better intra-observer agreement for LA function (ICC LAEF Total: 0.96 vs. 0.84).
Conclusions:
- The Bi-ALM's geometric assumptions do not accurately reflect complex LA anatomy.
- Simpson's method using transversal slices provides more accurate LA volume and function quantification.
- Accurate LA assessment with Simpson's method may improve cardiovascular risk prediction.
Abstract:
Left atrial (LA) enlargement and dysfunction are markers of chronic diastolic dysfunction and an important predictor of adverse cardiovascular and cerebrovascular outcomes. Accordingly, accurate quantification of left atrial volume (LAV) and function is needed. In routine clinical cardiovascular magnetic resonance (CMR) imaging the biplane area-length method (Bi-ALM) is frequently applied due to time-saving image acquisition and analysis. However, given the varying anatomy of the LA we hypothesized that the diagnostic accuracy of the Bi-ALM is not sufficient and that results would be different from a precise volumetric assessment of transversal multi-slice cine images using Simpson's method. Thirty one patients of the FIND-AFRANDOMISED-study with status post acute cerebral ischemia (mean age 70.5 ± 6.2 years) received CMR imaging at 3T. The study protocol included cine SSFP sequences in standard 2- and 4 CV and a stack of contiguous slices in transversal orientation. Total, passive and active LA emptying fractions were calculated from LA maximal volume, minimal volume and volume prior to atrial contraction. Intra- and inter-observer variability was assessed in ten patients. Significant differences were found for LA volume and phasic function. The Bi-ALM significantly underestimated LA volume and overestimated LA function in comparison to Simpson's method (Bi-ALM vs. Simpson's method: LAVmax: 80.18 vs. 98.80 ml; LAVpre-ac: 61.09 vs. 80.41 ml; LAVmin: 36.85 vs. 52.66 ml; LAEFTotal: 55.17 vs. 47.85%; LAEFPassive: 23.96 vs. 19.15%; LAEFBooster: 40.87 vs. 35.64%). LA volumetric and functional parameters were reproducible on an intra- and inter-observer levels for both methods. Intra-observer agreement for LA function was better for Simpson's method (Bi-ALM vs. Simpson's method; ICC LAEFTotal: 0.84 vs. 0.96; ICC LAEFPassive: 0.74 vs. 0.92; ICC LAEFBooster: 0.86 vs. 0.89). The Bi-ALM is based on geometric assumptions that do not reflect the complex individual LA geometry. The assessment of transversal slices covering the left atrium with Simpson's method is feasible and might be more suitable for an accurate quantification of LA volume and phasic function.
