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Updated: May 29, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Correlation between left atrium fractal dimension and cardiac function in patients with atrial fibrillation
Mengyuan Jing1,2,3,4, Fengyan Wang4,5,6,7, Huaze Xi4,5,6,7
1Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Sciences, Guangzhou, 510030, China.
Insights
Left atrial fractal dimension (FD) correlates with left ventricular (LV) systolic function in atrial fibrillation (AF) patients. This novel LA morphology metric may aid in assessing LV function alongside traditional measures.
Area of Science:
- Cardiology and Cardiovascular Imaging
- Medical Imaging Analysis
- Cardiac Electrophysiology
Background:
- Atrial fibrillation (AF) is associated with significant alterations in cardiac structure and function.
- Left ventricular (LV) systolic function is a critical determinant of cardiac health and prognosis in AF patients.
- Traditional measures of left atrial (LA) size, such as LA diameter (LAD), are known to correlate with LV function.
Purpose of the Study:
- To investigate the association between novel left atrial (LA) morphology, quantified by fractal dimension (FD), and left ventricular (LV) systolic function in patients with atrial fibrillation (AF).
- To compare the utility of LA fractal dimension (FD) with the conventional LA diameter (LAD) in assessing LV systolic function.
Main Methods:
- A cohort of 1066 patients admitted for AF between December 2018 and December 2022 underwent cardiac computed tomography angiography (CTA) and transthoracic echocardiography.
- LV systolic function was assessed via transthoracic echocardiography, measuring ejection fraction (EF) and fractional shortening (FS).
- LA morphology was quantified using fractal dimension (FD) from cardiac CTA images, with LA diameter (LAD) also measured.
Main Results:
- Both LAD and LA FD showed significant correlations with LV systolic function parameters (EF, FS, end-diastolic volume [EDV], end-systolic volume [ESV]).
- LA FD exhibited a significant negative correlation with EF (r=-0.092, P=.003) and FS (r=-0.083, P=.007), and a positive correlation with EDV (r=0.086, P=.005) and ESV (r=0.094, P=.002).
- Nonlinear relationships were observed between LA FD and EDV/ESV, while a linear inverse association was found with EF.
Conclusions:
- Left atrial fractal dimension (FD) is significantly correlated with left ventricular (LV) systolic function in patients with atrial fibrillation (AF).
- LA morphology, as assessed by FD, may serve as a valuable tool for evaluating LV systolic function in AF patients.
- LA FD offers complementary information to traditional LA diameter (LAD) for assessing altered LV systolic function in this population.
Objective:
To investigate the correlation between left atrial (LA) morphology and left ventricular (LV) systolic function in patients with atrial fibrillation (AF).
Methods:
We studied 1 066 patients admitted to our institution between December 2018 and December 2022 for AF. All patients underwent cardiac computed tomography angiography (CTA) and transthoracic echocardiography. LV systolic function was assessed using transthoracic echocardiography. On cardiac CTA images, we measured the LA diameter (LAD) and quantified LA morphology using the fractal dimension (FD). The primary focus was association between the novel LA FD and LV systolic function, while LAD was included as a conventional comparator.
Results:
Correlation analysis showed that LAD was negatively associated with the ejection fraction (EF) (r=-.175, P < .001) and fractional shortening (FS) (r=-.172, P < .001) and positively associated with end-systolic volume (ESV) (r = .090, P = .003). LA FD was negatively correlated with the EF (r=-.092, P = .003) and FS (r=-.083, P = .007) and positively correlated with end-diastolic volume (EDV) (r = .086, P = .005) and ESV (r = .094, P = .002). The restricted cubic spline (RCS) curves with four knots demonstrated a nonlinear correlation between LA FD and ESV (overall P = .046, nonlinear P = .035) and EDV (overall P = .002, nonlinear P < .001) and a linear relationship with EF (P = .037, P = .125). Specifically, EF demonstrated a continuous inverse linear association with increasing LA FD, whereas EDV and ESV followed a complex multiphasic pattern rather than a simple monotonic trend.
Conclusions:
The correlation between LV systolic function and LA FD suggests that LA shape may also be used as a tool to assess LV systolic function in patients with AF.
Advances In Knowledge:
In addition to LAD, LA FD may also provide clues to altered LV systolic function in this patient population.
