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Updated: Jan 29, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Prognostic Value of Atrial Phasic Dysfunction by CMR Feature Tracking for New-Onset Atrial Fibrillation in Patients
Nicoleta Nita1, Johannes Mörike1, Dominik Felbel1
1Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
Insights
Assessing left atrial reservoir strain using cardiac magnetic resonance (CMR) can help predict new-onset atrial fibrillation (AF) in cardiac sarcoidosis (CS) patients. This finding is crucial for early risk stratification in newly diagnosed CS.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Sarcoidosis Research
Background:
- Cardiac sarcoidosis (CS) poses a risk for new-onset atrial fibrillation (AF).
- The role of left atrial (LA) phasic function assessment in predicting AF in CS patients is not well-established.
- Cardiac magnetic resonance (CMR) allows detailed evaluation of LA function.
Purpose of the Study:
- To investigate the prognostic value of LA phasic dysfunction, assessed by CMR feature tracking, for predicting new-onset AF in patients with newly diagnosed CS.
- To compare LA function and AF incidence between clinically manifest and clinically silent CS.
- To identify independent predictors of AF in different CS subgroups.
Main Methods:
- 78 patients with newly diagnosed CS and no prior AF history underwent CMR feature tracking.
- Follow-up of up to 4 years included Holter monitoring and device interrogation for AF detection.
- Patients were categorized into clinically manifest CS and clinically silent CS groups.
Main Results:
- Patients with clinically manifest CS showed poorer ventricular function and significantly reduced LA reservoir, conduit, and booster function compared to those with clinically silent CS.
- Over 4 years, 39% of patients with clinically manifest CS and 29.7% with clinically silent CS developed AF.
- Reduced LA reservoir strain was a strong predictor of AF in the entire cohort. In subgroup analysis, LA reservoir strain predicted AF in clinically silent CS, while NT-proBNP predicted AF in clinically manifest CS.
Conclusions:
- Reduced left atrial reservoir strain, as measured by CMR, is a significant predictor of new-onset atrial fibrillation in patients with newly diagnosed cardiac sarcoidosis.
- The predictive power of LA reservoir strain is most pronounced in clinically silent CS and diminishes with disease progression in clinically manifest CS.
- CMR-based assessment of LA function offers valuable insights for AF risk stratification in CS patients.
Abstract:
Background/Objectives: It is unclear whether assessment of phasic atrial function could improve risk stratification for new-onset atrial fibrillation (AF) in patients with newly diagnosed cardiac sarcoidosis (CS). We aimed to investigate the prognostic value of left atrial (LA) phasic dysfunction by cardiac magnetic resonance (CMR) for new-onset AF in newly diagnosed patients with CS. Methods: 78 patients with CS, without a prior history of AF, were studied using CMR feature tracking. Over a 4-year follow-up period, AF was documented by Holter monitoring and interrogation of intracardiac devices. Clinically silent CS was defined as CS in patients with biopsy-proven extracardiac sarcoidosis, with no cardiac symptoms, but with abnormalities on CMR or positron emission tomography consistent with CS. Results: Patients with clinically manifest CS were younger (mean age 56 vs. 51 years, p = 0.018), had poorer ventricular function, higher extent of atrial late gadolinium enhancement and significantly lower LA reservoir, conduit and booster function compared to patients with clinically silent CS. Over a 4-year follow-up period, 39% of patients with clinically manifest CS and 29.7% of patients with clinically silent CS developed AF. LA reservoir strain was a strong predictor of AF in the entire cohort. In subgroup analysis, age (HR 1.30, 95% CI 1.02-1.65, p = 0.030) and LA reservoir strain (HR 0.63, 95% CI 0.44-0.90, p = 0.011) were independent predictors of AF in patients with clinically silent CS, whereas baseline NT-proBNP (HR 1.003, 95% CI 1.001-1.006, p = 0.017) predicted AF in patients with clinically manifest CS. Conclusions: Reduced LA reservoir strain on CMR predicts new-onset AF in patients with newly diagnosed CS. The predictive value of LA reservoir strain is strongest in clinically silent CS and decreases with disease progression in clinically manifest CS.
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