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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Left atrial dysfunction may precede left atrial enlargement and abnormal left ventricular longitudinal function: a

Di Zhou1, Wenjing Yang1, Yingxia Yang1,2

  • 1Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China.

BMC Cardiovascular Disorders
|March 14, 2022
PubMed

Insights

Left atrial (LA) dysfunction, measured by cardiovascular magnetic resonance feature tracking (CMR-FT) strain, is an early indicator of cardiovascular disease in patients with hypertrophic cardiomyopathy (HCM) and hypertension (HTN). This LA strain is more sensitive than LV longitudinal strain for predicting adverse clinical events.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Left atrial (LA) dysfunction is increasingly recognized as a factor in cardiovascular disease development.
  • Cardiovascular magnetic resonance feature tracking (CMR-FT) allows for detailed assessment of cardiac mechanics.

Purpose of the Study:

  • To compare the impact of hypertrophic cardiomyopathy (HCM) and hypertension (HTN) on LA function in patients without LA enlargement using CMR-FT.
  • To explore the capability of LA function metrics in predicting clinical outcomes in the early stages of cardiovascular disease.

Main Methods:

  • Retrospective analysis of 60 HCM patients, 60 HTN patients (normal LA size), and 60 controls using CMR.
  • Quantification of LA and left ventricular (LV) functions via volumetric and CMR-FT strain analysis.
  • Primary endpoint: composite of all-cause death, stroke, heart failure hospitalization, and atrial fibrillation.

Main Results:

  • Both HTN and HCM groups exhibited impaired LA reservoir (εs) and conduit (εe) functions compared to controls.
  • LA strain parameters (εs, εe, εa) were more sensitive than LV longitudinal strain (GLS) in evaluating the primary endpoint.
  • Impaired LA reservoir and booster pump strain were significantly associated with adverse clinical outcomes over a 6.8-year follow-up.

Conclusions:

  • CMR-FT-derived LA strain is a robust tool for assessing LA mechanics and dynamics in early-stage HTN and HCM.
  • LA dysfunction is a promising metric for assessing clinical implications and predicting prognosis, outperforming GLS.
Abstract

Keywords:
Atrial functionCardiomyopathyHypertensionHypertrophicMagnetic resonance imaging

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