Journal articles: 'Left atrium; atrial fibrillation; cardiac magnetic resonance imaging'

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Kuchynka, Petr, Jana Podzimkova, Martin Masek, Lukas Lambert, Vladimir Cerny, Barbara Danek, and Tomas Palecek. "The Role of Magnetic Resonance Imaging and Cardiac Computed Tomography in the Assessment of Left Atrial Anatomy, Size, and Function." BioMed Research International 2015 (2015): 1–13. http://dx.doi.org/10.1155/2015/247865.

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In the last decade, there has been increasing evidence that comprehensive evaluation of the left atrium is of utmost importance. Numerous studies have clearly demonstrated the prognostic value of left atrial volume for long-term outcome. Furthermore, advances in catheter ablation procedures used for the treatment of drug-refractory atrial fibrillation require the need for detailed knowledge of left atrial and pulmonary venous morphology as well of atrial wall characteristics. This review article discusses the role of cardiac magnetic resonance and computed tomography in assessment of left atrial size, its normal and abnormal morphology, and function. Special interest is paid to the utility of these rapidly involving noninvasive imaging methods before and after atrial fibrillation ablation.

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Ji, Mengmeng, Lin He, Lang Gao, Yixia Lin, Mingxing Xie, and Yuman Li. "Assessment of Left Atrial Structure and Function by Echocardiography in Atrial Fibrillation." Diagnostics 12, no. 8 (August 5, 2022): 1898. http://dx.doi.org/10.3390/diagnostics12081898.

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Atrial fibrillation (AF) is the most common arrhythmia with significant morbidity and mortality. Exacerbated by the aging population, the prevalence of AF is gradually increasing. Accurate evaluation of structure and function of left atrium (LA) has important prognostic significance in patients with AF. Echocardiography is the imaging technique of first choice to assess LA structure and function due to its better availability, accessibility and safety over cardiac computed tomography and cardiac magnetic resonance. Therefore, the aim of this review is to summarize the recent research progress of evaluating LA size by three-dimensional echocardiography and LA function by speckle tracking echocardiography (STE) in predicting the occurrence and recurrence of AF and determining the risk of stroke in AF. In addition, we summarized the role of traditional echocardiography in detecting AF patients that are at high risk of heart failure or cardiovascular death.

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Moral, Sergio, Marc Abulí, Pau Vilardell, Emilce Trucco, Esther Ballesteros, and Ramon Brugada. "Multimodality Imaging in the Study of the Left Atrium." Journal of Clinical Medicine 11, no. 10 (May 18, 2022): 2854. http://dx.doi.org/10.3390/jcm11102854.

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The left atrium (LA) plays a vital role in maintaining normal cardiac function. Many cardiac diseases involve the functioning of the LA directly or indirectly. For this reason, the study of the LA has become a priority for today’s imaging techniques. Assessment of LA size, function and wall characteristics is routinely performed in cardiac imaging laboratories when a patient undergoes transthoracic echocardiography. However, in cases when the LA is the focus of disease management, such as in atrial fibrillation or left atrial appendage closure, the use of multimodality is critical. Knowledge of the usefulness of each cardiac imaging technique for the study of LA in these patients is crucial in order to choose the most appropriate treatment. While echocardiography is the most widely performed technique for its evaluation and the study of wall deformation analysis is increasingly becoming more reliable, multidetector computed tomography allows a detailed analysis of its anatomy to be carried out in 3D reconstructions that help in the approach to interventional treatments. In addition, the evaluation of the wall by cardiac magnetic resonance imaging or the generation of electroanatomical maps in the electrophysiology room have become essential tools in the treatment of multiple atrial pathologies. For this reason, the goal of this review article is to describe the basic anatomical and functional information of the LA as well as their study employing the main imaging techniques currently available, so that practitioners specializing in cardiac imaging techniques can use these tools in an accurate and clinically useful manner.

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Tore, Davide, Riccardo Faletti, Andrea Biondo, Andrea Carisio, Fabio Giorgino, Ilenia Landolfi, Katia Rocco, et al. "Role of Cardiovascular Magnetic Resonance in the Management of Atrial Fibrillation: A Review." Journal of Imaging 8, no. 11 (November 4, 2022): 300. http://dx.doi.org/10.3390/jimaging8110300.

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Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is growing with time. Since the introduction of catheter ablation procedures for the treatment of AF, cardiovascular magnetic resonance (CMR) has had an increasingly important role for the treatment of this pathology both in clinical practice and as a research tool to provide insight into the arrhythmic substrate. The most common applications of CMR for AF catheter ablation are the angiographic study of the pulmonary veins, the sizing of the left atrium (LA), and the evaluation of the left atrial appendage (LAA) for stroke risk assessment. Moreover, CMR may provide useful information about esophageal anatomical relationship to LA to prevent thermal injuries during ablation procedures. The use of late gadolinium enhancement (LGE) imaging allows to evaluate the burden of atrial fibrosis before the ablation procedure and to assess procedural induced scarring. Recently, the possibility to assess atrial function, strain, and the burden of cardiac adipose tissue with CMR has provided more elements for risk stratification and clinical decision making in the setting of catheter ablation planning of AF. The purpose of this review is to provide a comprehensive overview of the potential applications of CMR in the workup of ablation procedures for atrial fibrillation.

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Floria, Mariana, Smaranda Radu, Evelina Maria Gosav, Dragos Cozma, Ovidiu Mitu, Anca Ouatu, Daniela Maria Tanase, Viorel Scripcariu, and Lacramioara Ionela Serban. "Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?" Diagnostics 10, no. 3 (March 2, 2020): 137. http://dx.doi.org/10.3390/diagnostics10030137.

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Left atrial structural, functional and electrical remodelling are linked to atrial fibrillation (AF) pathophysiology and mirror the phrase “AF begets AF”. A structurally remodelled left atrium (LA) is fibrotic, dysfunctional and enlarged. Fibrosis is the hallmark of LA structural remodelling and is associated with increased risk of stroke, heart failure development and/or progression and poorer catheter ablation outcomes with increased recurrence rates. Moreover, increased atrial fibrosis has been associated with higher rates of stroke even in sinus-rhythm individuals. As such, properly assessing the fibrotic atrial cardiomyopathy in AF patients becomes necessary. In this respect, late-gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard in imaging myocardial fibrosis. LA structural remodelling extension offers both diagnostic and prognostic information and influences therapeutic choices. LGE-CMR scans can be used before the procedure to better select candidates and to aid in choosing the ablation technique, during the procedure (full CMR-guided ablations) and after the ablation (to assess the ablation scar). This review focuses on imaging several LA structural remodelling CMR parameters, including size, shape and fibrosis (both extension and architecture) and their impact on procedure outcomes, recurrence risk, as well as their utility in relation to the index procedure timing.

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Shams, Khaled A. "When the left atrium becomes a monster: a case report." European Heart Journal - Case Reports 4, no. 4 (June 17, 2020): 1–4. http://dx.doi.org/10.1093/ehjcr/ytaa128.

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Abstract Background Congenital left atrium (LA) aneurysms are extremely rare entities in clinical practice and most frequently involve the atrial appendage and rarely arise from the body of LA, We report a case of giant LA aneurysm compressing heart and presenting in a very late stage. Case summary A 31-year-old male, who was diagnosed to have dextrocardia, rheumatic heart disease, and atrial fibrillation and was kept on medical treatment long time ago, presented with congestive heart failure symptoms and cardiogenic shock. Emergency transthoracic echocardiography was done revealing situs solitus with aneurysmally dilated LA pushing heart to the right side (dextro-posed heart), moderate mitral regurgitation, and severe pulmonary hypertension, however, pulmonary artery anatomy could not be properly visualized so computed tomography (CT) was preformed confirming diagnosis and revealing compressed pulmonary arterial tree by the dilated LA, unfortunately patient died before proceeding to surgical intervention. Discussion Congenital left atrial aneurysms are extremely rare anomaly and may be associated with significant morbidity. And, therefore, should be remembered as a potential anatomic cause of atrial arrhythmias or embolic phenomena, or both. The diagnosis may be easily established through non-invasive complementary techniques, such as echocardiography, CT, and cardiac magnetic resonance imaging. Symptomatic patients, those with large aneurysm or compelling indications for surgery should undergo surgical resection.

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Haemers, Peter, Piet Claus, and Rik Willems. "The Use of Cardiac Magnetic Resonance Imaging in the Diagnostic Workup and Treatment of Atrial Fibrillation." Cardiology Research and Practice 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/658937.

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Atrial fibrillation (AF) is the most common cardiac arrhythmia and imposes a huge clinical and economic burden. AF is correlated with an increased morbidity and mortality, mainly due to stroke and heart failure. Cardiovascular imaging modalities, including echocardiography, computed tomography (CT), and cardiovascular magnetic resonance (CMR), play a central role in the workup and treatment of AF. One of the major advantages of CMR is the high contrast to noise ratio combined with good spatial and temporal resolution, without any radiation burden. This allows a detailed assessment of the structure and function of the left atrium (LA). Of particular interest is the ability to visualize the extent of LA wall injury. We provide a focused review of the value of CMR in identifying the underlying pathophysiological mechanisms of AF, its role in stroke prevention and in the guidance of radiofrequency catheter ablation. CMR is a promising technique that could add valuable information for therapeutic decision making in specific subpopulations with AF.

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Peters, Dana C., Jérôme Lamy, Albert J. Sinusas, and Lauren A. Baldassarre. "Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers." European Heart Journal - Cardiovascular Imaging 23, no. 1 (October 29, 2021): 14–30. http://dx.doi.org/10.1093/ehjci/jeab221.

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Abstract Left atrial (LA) imaging is still not routinely used for diagnosis and risk stratification, although recent studies have emphasized its importance as an imaging biomarker. Cardiovascular magnetic resonance is able to evaluate LA structure and function, metrics that serve as early indicators of disease, and provide prognostic information, e.g. regarding diastolic dysfunction, and atrial fibrillation (AF). MR angiography defines atrial anatomy, useful for planning ablation procedures, and also for characterizing atrial shapes and sizes that might predict cardiovascular events, e.g. stroke. Long-axis cine images can be evaluated to define minimum, maximum, and pre-atrial contraction LA volumes, and ejection fractions (EFs). More modern feature tracking of these cine images provides longitudinal LA strain through the cardiac cycle, and strain rates. Strain may be a more sensitive marker than EF and can predict post-operative AF, AF recurrence after ablation, outcomes in hypertrophic cardiomyopathy, stratification of diastolic dysfunction, and strain correlates with atrial fibrosis. Using high-resolution late gadolinium enhancement (LGE), the extent of fibrosis in the LA can be estimated and post-ablation scar can be evaluated. The LA LGE method is widely available, its reproducibility is good, and validations with voltage-mapping exist, although further scan–rescan studies are needed, and consensus regarding atrial segmentation is lacking. Using LGE, scar patterns after ablation in AF subjects can be reproducibly defined. Evaluation of ‘pre-existent’ atrial fibrosis may have roles in predicting AF recurrence after ablation, predicting new-onset AF and diastolic dysfunction in patients without AF. LA imaging biomarkers are ready to enter into diagnostic clinical practice.

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Moulki, Naeem, Aneeq Waqar, Nancy Schoenecker, Cara Joyce, and Mushabbar A. Syed. "EFFECTS OF ATRIAL FIBRILLATION ABLATION ON LEFT ATRIAL FUNCTION AS EVALUATED ON CARDIAC MAGNETIC RESONANCE IMAGING." Journal of the American College of Cardiology 75, no. 11 (March 2020): 280. http://dx.doi.org/10.1016/s0735-1097(20)30907-4.

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Thosani, Amit J., Paul Gerczuk, Emerson Liu, William Belden, and Robert Moraca. "Closed Chest Convergent Epicardial–Endocardial Ablation of Non-paroxysmal Atrial Fibrillation – A Case Series and Literature Review." Arrhythmia & Electrophysiology Review 2, no. 1 (2013): 65. http://dx.doi.org/10.15420/aer.2013.2.1.65.

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The closed chest convergent procedure is a multidisciplinary approach to atrial fibrillation (AF) treatment. Epicardial posterior left atrial (PLA) ablation is performed by a cardiac surgeon using a transdiaphragmatic endoscope, immediately followed by percutaneous pulmonary vein (PV) isolation performed by a cardiac electrophysiologist. Interim outcomes for the treatment of non-paroxysmal AF (NPAF) were evaluated based on peri-procedural safety and complications, freedom from recurrent AF, and need for cardioversion or repeat catheter ablation at three, six and 12 months post-procedure. A total of 43 patients (86 % NPAF) underwent the convergent procedure. Patients were 84 % male, with mean age 58.6 ± 8.7 years. Mean AF duration was 45.4 ± 40.3 months. Pre-procedure left atrium (LA) volumetric data using cardiac magnetic resonance imaging (MRI) or computed tomography (CT) was available for 30 patients (70 %). Average LA volume was 155.5 ± 48.4 millilitres (ml); two-thirds of patients had a LA volume >130 ml. There was no operative or peri-operative mortality. Sinus rhythm (SR) was recorded at three months in 31 of 39 (79 %) patients, at six months in 24 of 27 (89 %) patients and at 12 months in nine patients. The convergent procedure is a safe and effective option for both PV isolation and PLA substrate ablation in NPAF patients. Long-term follow-up is required and randomised clinical trials warranted.

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Benjamin, Mina M., Harish Ravipati, Naeem Moulki, Aneeq Waqar, Nancy Schoenecker, and Mushabbar Syed. "LEFT ATRIAL STRAIN BY CARDIAC MAGNETIC RESONANCE IMAGING PREDICTS RECURRENCE OF PAROXYSMAL ATRIAL FIBRILLATION FOLLOWING CATHETER ABLATION." Journal of the American College of Cardiology 77, no. 18 (May 2021): 1304. http://dx.doi.org/10.1016/s0735-1097(21)02662-0.

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Robertson, Jason O., Anson M. Lee, Rochus K. Voeller, Marci S. Damiano, Richard B. Schuessler, and Ralph J. Damiano. "Quantification of the functional consequences of atrial fibrillation and surgical ablation on the left atrium using cardiac magnetic resonance imaging." European Journal of Cardio-Thoracic Surgery 46, no. 4 (February 11, 2014): 720–28. http://dx.doi.org/10.1093/ejcts/ezt656.

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Ma, Chao, Gongning Luo, and Kuanquan Wang. "A Combined Random Forests and Active Contour Model Approach for Fully Automatic Segmentation of the Left Atrium in Volumetric MRI." BioMed Research International 2017 (2017): 1–14. http://dx.doi.org/10.1155/2017/8381094.

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Segmentation of the left atrium (LA) from cardiac magnetic resonance imaging (MRI) datasets is of great importance for image guided atrial fibrillation ablation, LA fibrosis quantification, and cardiac biophysical modelling. However, automated LA segmentation from cardiac MRI is challenging due to limited image resolution, considerable variability in anatomical structures across subjects, and dynamic motion of the heart. In this work, we propose a combined random forests (RFs) and active contour model (ACM) approach for fully automatic segmentation of the LA from cardiac volumetric MRI. Specifically, we employ the RFs within an autocontext scheme to effectively integrate contextual and appearance information from multisource images together for LA shape inferring. The inferred shape is then incorporated into a volume-scalable ACM for further improving the segmentation accuracy. We validated the proposed method on the cardiac volumetric MRI datasets from the STACOM 2013 and HVSMR 2016 databases and showed that it outperforms other latest automated LA segmentation methods. Validation metrics, average Dice coefficient (DC) and average surface-to-surface distance (S2S), were computed as0.9227±0.0598and1.14±1.205 mm, versus those of 0.6222–0.878 and 1.34–8.72 mm, obtained by other methods, respectively.

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Carter-Storch, Rasmus, Jordi S. Dahl, Nicolaj L. Christensen, Redi Pecini, Eva V. Søndergård, Kristian Altern Øvrehus, and Jacob E. Møller. "Postoperative atrial fibrillation after aortic valve replacement is a risk factor for long-term atrial fibrillation." Interactive CardioVascular and Thoracic Surgery 29, no. 3 (April 11, 2019): 378–85. http://dx.doi.org/10.1093/icvts/ivz094.

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AbstractOBJECTIVESPostoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. However, knowledge on the rate of long-term atrial fibrillation (LTAF) after POAF remains unclear. We investigated predictors of POAF in patients with aortic stenosis undergoing surgical aortic valve replacement, and assessed the rate of LTAF during follow-up.METHODSWe prospectively included 96 adult patients with severe aortic stenosis undergoing surgical aortic valve replacement. Patients with previous atrial fibrillation (AF) were excluded. Patients underwent echocardiography, cardiac computed tomography and magnetic resonance imaging immediately prior to surgery. Surgical aortic clamp time and postoperative C-reactive protein (CRP) were documented. POAF was defined as AF recorded within 7 days of surgery. Through chart review, patients were followed up for documented episodes of LTAF occurring more than 7 days after surgery.RESULTSPOAF occurred in 51 patients (53%). It was associated with larger preoperative echocardiographic left atrial volume index (44 ± 12 vs 37 ± 8 ml/m2, P = 0.004), longer aortic clamp time [80 (70–102) vs 72 (62–65) min, P = 0.04] and higher CRP on first postoperative day [80 (64–87) vs 65 (44–83) mg/l, P = 0.001]. Multivariable logistic regression revealed that left atrial volume index [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02–1.13; P = 0.005] and postoperative CRP (OR 1.03, 95% CI 1.01–1.05; P = 0.006) were the only independent predictors of POAF. During 695 days (25th–75th percentile: 498–859 days) of follow-up, LTAF occurred in 11 patients of whom 10 were in the POAF group (hazard ratio 9.4, 95% CI 1.2–74; P = 0.03).CONCLUSIONSPOAF is predicted by left atrial volume index and postoperative CRP. Patients with POAF have a 9-fold increase risk of developing symptomatic LTAF during follow-up.Clinical trial registration numberClinicalTrials.gov (NCT02316587).

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Cohen, Ariel, Erwan Donal, Victoria Delgado, Mauro Pepi, Teresa Tsang, Bernhard Gerber, Laurie Soulat-Dufour, et al. "EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography." European Heart Journal - Cardiovascular Imaging 22, no. 6 (March 12, 2021): e24-e57. http://dx.doi.org/10.1093/ehjci/jeab008.

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Abstract Cardioaortic embolism to the brain accounts for approximately 15–30% of ischaemic strokes and is often referred to as ‘cardioembolic stroke’. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain ‘cryptogenic’, recently redefined as ‘embolic strokes of undetermined source’. The diagnosis of cardioembolic stroke remains difficult because a potential cardiac source of embolism does not establish the stroke mechanism. The role of cardiac imaging—transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT), and magnetic resonance imaging (MRI)—in the diagnosis of potential cardiac sources of embolism, and for therapeutic guidance, is reviewed in these recommendations. Contrast TTE/TOE is highly accurate for detecting left atrial appendage thrombosis in patients with atrial fibrillation, valvular and prosthesis vegetations and thrombosis, aortic arch atheroma, patent foramen ovale, atrial septal defect, and intracardiac tumours. Both CT and MRI are highly accurate for detecting cavity thrombosis, intracardiac tumours, and valvular prosthesis thrombosis. Thus, CT and cardiac magnetic resonance should be considered in addition to TTE and TOE in the detection of a cardiac source of embolism. We propose a diagnostic algorithm where vascular imaging and contrast TTE/TOE are considered the first-line tool in the search for a cardiac source of embolism. CT and MRI are considered as alternative and complementary tools, and their indications are described on a case-by-case approach.

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Pastore, Maria Concetta, Giulia Elena Mandoli, Aleksander Dokollari, Gianluigi Bisleri, Matteo Lisia, Luna Cavigli, Flavio D’Ascenzi, Marta Focardi, and Matteo Cameli. "Left atrial fibrosis: an essential hallmark in chronic mitral regurgitation." Romanian Journal of Cardiology 31, no. 1 (March 31, 2021): 36–45. http://dx.doi.org/10.47803/rjc.2021.31.1.36.

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Chronic mitral regurgitation (MR) is the second valvular heart disease for incidence, which worsening severity gradually affects all cardiac chambers and leads to poor outcome if untreated. The recent development of minimally invasive surgical techniques and percutaneous intervention has reduced the operative risk, allowing a more confident referral of these patients for intervention. Therefore, there is a growing need of reliable markers to select the best therapeutic strategies and to identify the optimal timing for intervention. Myocardial fibrosis (MF) gradually occurs as a result of left atrial and ventricular (LA and LV) remodeling due to MR pressure and volume overload. It has been identifi ed as an index of clinical outcome and arrhythmic risk in patients with MR. Particularly, the assessment of LA fi brosis not only allows to define different MR etiology, but also was associated with prognosis and atrial fibrillation (AF) burden. Nowadays, noninvasive estimation of MF is possible through the use of advanced imaging modalities, particularly cardiac magnetic resonance and speckle tracking echocardiography. This review discusses the role of LA fibrosis as a diagnostic and prognostic marker in patients with MR and its quantification by noninvasive multimodality cardiac imaging.

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Aparina, O. P., O. V. Stukalova, D. V. Parkhomenko, N. A. Mironova, E. Y. Strazdenj, S. K. Ternovoy, and S. P. Golitsyn. "Structural and Functional Properties of the Left Atrium in Healthy Volunteers and Patients With Atrial Fibrillation: Data of Magnetic Resonance Imaging." Kardiologiia 17, no. 9 (2017): 5–13. http://dx.doi.org/10.18087/cardio.2017.9.10029.

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Hwang, Sung Ho, Yu-Whan Oh, Mi-Na Kim, Seong-Mi Park, Wan Joo Shim, Jaemin Shim, Jong-il Choi, and Young-Hoon Kim. "Relationship between left atrial appendage emptying and left atrial function using cardiac magnetic resonance in patients with atrial fibrillation: comparison with transesophageal echocardiography." International Journal of Cardiovascular Imaging 32, S1 (April 27, 2016): 163–71. http://dx.doi.org/10.1007/s10554-016-0893-1.

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Dodson, John A., Tomas G. Neilan, Ravi V. Shah, Hoshang Farhad, Ron Blankstein, Michael Steigner, Gregory F. Michaud, et al. "Left Atrial Passive Emptying Function Determined by Cardiac Magnetic Resonance Predicts Atrial Fibrillation Recurrence After Pulmonary Vein Isolation." Circulation: Cardiovascular Imaging 7, no. 4 (July 2014): 586–92. http://dx.doi.org/10.1161/circimaging.113.001472.

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Ciuffo, Luisa, Yuko Y. Inoue, Susumu Tao, Esra Gucuk Ipek, Muhammad Balouch, Joao A. C. Lima, Saman Nazarian, et al. "Mechanical dyssynchrony of the left atrium during sinus rhythm is associated with history of stroke in patients with atrial fibrillation." European Heart Journal - Cardiovascular Imaging 19, no. 4 (June 27, 2017): 433–41. http://dx.doi.org/10.1093/ehjci/jex156.

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Abstract Aims We sought to evaluate the relationship between left atrial (LA) mechanical dyssynchrony and history of stroke or transient ischaemic attack (TIA) in patients with atrial fibrillation (AF). We hypothesized that mechanical dyssynchrony of the LA is associated with history of stroke/TIA independent of LA function and Cardiac failure, Hypertension, Age, Diabetes, Stroke/transient ischaemic attack (TIA), VAscular disease, and Sex category (CHA2DS2-VASc) score in patients with AF. Methods and results We conducted a cross-sectional study of 246 patients with a history of AF (59 ± 10 years, 29% female, 26% non-paroxysmal AF) referred for catheter ablation to treat drug-refractory AF who underwent preablation cardiac magnetic resonance (CMR) in sinus rhythm. Using tissue-tracking CMR, we measured the LA longitudinal strain and strain rate in each of 12 equal-length segments in two- and four-chamber views. We defined indices of LA mechanical dyssynchrony, including the standard deviation of the time to the peak longitudinal strain (SD-TPS). Patients with a prior history of stroke or TIA (n = 23) had significantly higher SD-TPS than those without (n = 223) (39.9 vs. 23.4 ms, P < 0.001). Multivariable analysis showed that SD-TPS was associated with stroke/TIA after adjusting for the CHA2DS2-VASc score, LA minimum index volume, and the peak LA longitudinal strain (P < 0.001). The receiver-operating characteristics curve showed that SD-TPS identified patients with stroke/TIA more accurately than CHA2DS2-VASc score alone (c-statistics: 0.82 vs. 0.75, P < 0.001). Conclusion Higher mechanical dyssynchrony of the LA during sinus rhythm is associated with a history of stroke/TIA in patients with AF.

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Sivalokanathan, Sanjay, Tarek Zghaib, Gabriela V. Greenland, Nestor Vasquez, Shibani M. Kudchadkar, Effrosyni Kontari, Dai-Yin Lu, et al. "Hypertrophic Cardiomyopathy Patients With Paroxysmal Atrial Fibrillation Have a High Burden of Left Atrial Fibrosis by Cardiac Magnetic Resonance Imaging." JACC: Clinical Electrophysiology 5, no. 3 (March 2019): 364–75. http://dx.doi.org/10.1016/j.jacep.2018.10.016.

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Nori, David, Gilbert Raff, Vikesh Gupta, Ralph Gentry, Judith Boura, and David E. Haines. "Cardiac magnetic resonance imaging assessment of regional and global left atrial function before and after catheter ablation for atrial fibrillation." Journal of Interventional Cardiac Electrophysiology 26, no. 2 (July 23, 2009): 109–17. http://dx.doi.org/10.1007/s10840-009-9409-4.

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Lim, Daniel J., Bharath Ambale-Ventakesh, Mohammad R. Ostovaneh, Tarek Zghaib, Hiroshi Ashikaga, Colin Wu, Karol E. Watson, et al. "Change in left atrial function predicts incident atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis." European Heart Journal - Cardiovascular Imaging 20, no. 9 (July 29, 2019): 979–87. http://dx.doi.org/10.1093/ehjci/jez176.

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Abstract Aims Longitudinal change in left atrial (LA) structure and function could be helpful in predicting risk for incident atrial fibrillation (AF). We used cardiac magnetic resonance (CMR) imaging to explore the relationship between change in LA structure and function and incident AF in a multi-ethnic population free of clinical cardiovascular disease at baseline. Methods and results In the Multi-Ethnic Study of Atherosclerosis (MESA), 2338 participants, free at baseline of clinically recognized AF and cardiovascular disease, had LA volume and function assessed with CMR imaging, at baseline (2000–02), and at Exam 4 (2005–07) or 5 (2010–12). Free of AF, 124 participants developed AF over 3.8 ± 0.9 years (2015) following the second imaging. In adjusted Cox regression models, an average annualized change in all LA parameters were significantly associated with an increased risk of AF. An annual decrease of 1-SD unit in total LA emptying fractions (LAEF) was most strongly associated with risk of AF after adjusting for clinical risk factors for AF, baseline LA parameters, and left ventricular mass-to-volume ratio (hazard ratio per SD = 1.91, 95% confidence interval = 1.53–2.38, P < 0.001). The addition of change in total LAEF to an AF risk score improved model discrimination and reclassification (net reclassification improvement = 0.107, P = 0.017; integrative discrimination index = 0.049, P < 0.001). Conclusion In this multi-ethnic study population free of clinical cardiovascular disease at baseline, a greater increase in LA volumes and decrease in LA function were associated with incident AF. The addition of change in total LAEF to risk prediction models for AF improved model discrimination and reclassification of AF risk.

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Kis, Zsuzsanna, Astrid Amanda Hendriks, Taulant Muka, Wichor M. Bramer, Istvan Kovacs, and Tamas Szili-Torok. "The Role of Atrial Fibrosis Detected by Delayed - Enhancement MRI in Atrial Fibrillation Ablation." Current Medical Imaging Formerly Current Medical Imaging Reviews 16, no. 2 (January 24, 2020): 135–44. http://dx.doi.org/10.2174/1573405614666180806130327.

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Introduction: Atrial Fibrillation (AF) is associated with remodeling of the atrial tissue, which leads to fibrosis that can contribute to the initiation and maintenance of AF. Delayed- Enhanced Cardiac Magnetic Resonance (DE-CMR) imaging for atrial wall fibrosis detection was used in several studies to guide AF ablation. The aim of present study was to systematically review the literature on the role of atrial fibrosis detected by DE-CMR imaging on AF ablation outcome. Methods: Eight bibliographic electronic databases were searched to identify all published relevant studies until 21st of March, 2016. Search of the scientific literature was performed for studies describing DE-CMR imaging on atrial fibrosis in AF patients underwent Pulmonary Vein Isolation (PVI). Results: Of the 763 citations reviewed for eligibility, 5 articles (enrolling a total of 1040 patients) were included into the final analysis. The overall recurrence of AF ranged from 24.4 - 40.9% with median follow-up of 324 to 540 days after PVI. With less than 5-10% fibrosis in the atrial wall there was a maximum of 10% recurrence of AF after ablation. With more than 35% fibrosis in the atrial wall there was 86% recurrence of AF after ablation. Conclusion: Our analysis suggests that more extensive left atrial wall fibrosis prior ablation predicts the higher arrhythmia recurrence rate after PVI. The DE-CMR imaging modality seems to be a useful method for identifying the ideal candidate for catheter ablation. Our findings encourage wider usage of DE-CMR in distinct AF patients in a pre-ablation setting.

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Zhou, Mi, Chun-Ka Wong, Ka-Chun Un, Yuk-Ming Lau, Jeffrey Chun-Yin Lee, Frankie Chor-Cheung Tam, Yee-Man Lau, et al. "Cardiovascular sequalae in uncomplicated COVID-19 survivors." PLOS ONE 16, no. 2 (February 11, 2021): e0246732. http://dx.doi.org/10.1371/journal.pone.0246732.

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Background A high proportion of COVID-19 patients were reported to have cardiac involvements. Data pertaining to cardiac sequalae is of urgent importance to define subsequent cardiac surveillance. Methods We performed a systematic cardiac screening for 97 consecutive COVID-19 survivors including electrocardiogram (ECG), echocardiography, serum troponin and NT-proBNP assay 1–4 weeks after hospital discharge. Treadmill exercise test and cardiac magnetic resonance imaging (CMR) were performed according to initial screening results. Results The mean age was 46.5 ± 18.6 years; 53.6% were men. All were classified with non-severe disease without overt cardiac manifestations and did not require intensive care. Median hospitalization stay was 17 days and median duration from discharge to screening was 11 days. Cardiac abnormalities were detected in 42.3% including sinus bradycardia (29.9%), newly detected T-wave abnormality (8.2%), elevated troponin level (6.2%), newly detected atrial fibrillation (1.0%), and newly detected left ventricular systolic dysfunction with elevated NT-proBNP level (1.0%). Significant sinus bradycardia with heart rate below 50 bpm was detected in 7.2% COVID-19 survivors, which appeared to be self-limiting and recovered over time. For COVID-19 survivors with persistent elevation of troponin level after discharge or newly detected T wave abnormality, echocardiography and CMR did not reveal any evidence of infarct, myocarditis, or left ventricular systolic dysfunction. Conclusion Cardiac abnormality is common amongst COVID-survivors with mild disease, which is mostly self-limiting. Nonetheless, cardiac surveillance in form of ECG and/or serum biomarkers may be advisable to detect more severe cardiac involvement including atrial fibrillation and left ventricular dysfunction.

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Sheitt, Hana, Hansuk Kim, Stephen Wilton, James A. White, and Julio Garcia. "Left Atrial Flow Stasis in Patients Undergoing Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Using 4D-Flow Magnetic Resonance Imaging." Applied Sciences 11, no. 12 (June 11, 2021): 5432. http://dx.doi.org/10.3390/app11125432.

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Atrial fibrillation (AF) is associated with systemic thrombo-embolism and stroke events, which do not appear significantly reduced following successful pulmonary vein (PV) ablation. Prior studies supported that thrombus formation is associated with left atrial (LA) flow alterations, particularly flow stasis. Recently, time-resolved three-dimensional phase-contrast (4D-flow) showed the ability to quantify LA stasis. This study aims to demonstrate that LA stasis, derived from 4D-flow, is a useful biomarker of LA recovery in patients with AF. Our hypothesis is that LA recovery will be associated with a reduction in LA stasis. We recruited 148 subjects with paroxysmal AF (40 following 3–4 months PV ablation and 108 pre-PV ablation) and 24 controls (CTL). All subjects underwent a cardiac magnetic resonance imaging (MRI) exam, inclusive of 4D-flow. LA was isolated within the 4D-flow dataset to constrain stasis maps. Control mean LA stasis was lower than in the pre-ablation cohort (30 ± 12% vs. 47 ± 18%, p < 0.001). In addition, mean LA stasis was reduced in the post-ablation cohort compared with pre-ablation (36 ± 15% vs. 47 ± 18%, p = 0.002). This study demonstrated that 4D flow-derived LA stasis mapping is clinically relevant and revealed stasis changes in the LA body pre- and post-pulmonary vein ablation.

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Rabbat, Mark G., David Wilber, Kevin Thomas, Owais Malick, Atif Bashir, Anoop Agrawal, Santanu Biswas, Thriveni Sanagala, and Mushabbar A. Syed. "Left atrial volume assessment in atrial fibrillation using multimodality imaging: a comparison of echocardiography, invasive three-dimensional CARTO and cardiac magnetic resonance imaging." International Journal of Cardiovascular Imaging 31, no. 5 (March 12, 2015): 1011–18. http://dx.doi.org/10.1007/s10554-015-0641-y.

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Spartera, Marco, Antonio Stracquadanio, Guilherme Pessoa-Amorim, Adam Von Ende, Alison Fletcher, Peter Manley, Vanessa M. Ferreira, et al. "The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics." European Heart Journal - Cardiovascular Imaging 23, no. 1 (October 23, 2021): 115–23. http://dx.doi.org/10.1093/ehjci/jeab213.

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Abstract Aims Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR). Methods and results We investigated 95 individuals: 37 patients with persistent AF, who were studied before and after cardioversion [Group 1; median CHA2DS2-VASc = 2.0 (1.5–3.5)]; 35 individuals with no history of AF but similar stroke risk to Group 1 [Group 2; median CHA2DS2-VASc = 3.0 (2.0–4.0)]; and 23 low-risk individuals in SR [Group 3; median CHA2DS2-VASc = 0.0 (0.0–0.0)]. Cardiac function and LA flow characteristics were evaluated using cardiac magnetic resonance. Before cardioversion, Group 1 displayed impaired left ventricular (LV) and LA function, reduced LA flow velocities and vorticity, and a higher normalized vortex volume (all P < 0.001 vs. Groups 2 and 3). After restoration of SR at ≥4-week post-cardioversion, LV systolic function and LA flow parameters improved significantly (all P < 0.001 vs. pre-cardioversion) and were no longer different from those in Group 2. However, in the presence of SR, LA flow peak and mean velocity, and vorticity were lower in Groups 1 and 2 vs. Group 3 (all P < 0.01), and were associated with impaired LA emptying fraction (LAEF) and LV diastolic dysfunction. Conclusion Patients at moderate-to-high stroke risk display altered LA flow characteristics in SR in association with an LA myopathic phenotype and LV diastolic dysfunction, regardless of a history of AF.

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Ghafouri, Khashayar, Kyle B. Franke, Fang Shawn Foo, and Martin K. Stiles. "Clinical utility of cardiac magnetic resonance imaging to assess the left atrium before catheter ablation for atrial fibrillation - A systematic review and meta-analysis." International Journal of Cardiology 339 (September 2021): 192–202. http://dx.doi.org/10.1016/j.ijcard.2021.07.030.

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Bertelsen, Litten, Søren Zöga Diederichsen, Ketil Jørgen Haugan, Axel Brandes, Claus Graff, Derk Krieger, Christian Kronborg, et al. "Left atrial volume and function assessed by cardiac magnetic resonance imaging are markers of subclinical atrial fibrillation as detected by continuous monitoring." EP Europace 22, no. 5 (March 3, 2020): 724–31. http://dx.doi.org/10.1093/europace/euaa035.

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Abstract Aims We aimed to investigate whether left atrial (LA) markers from cardiovascular magnetic resonance (CMR) were able to predict atrial fibrillation (AF) in elderly patients with risk factors for stroke. Methods and results At baseline, 203 participants with stroke risk factors but without history of AF underwent advanced CMR and received an implantable loop recorder. During a median of 40 (37–42) months of continuous monitoring, incident AF was detected in 79 patients (39%). With regards to CMR markers, a steep increase in incidence rate of AF was seen with LA maximum volume (LAmax) above 55 mL/m2, LA minimum volume (LAmin) above 30 mL/m2, LA total emptying fraction (LA TEF) below 45%, LA active emptying fraction (LA AEF) below 37%, LA strain S below 25%, LA strain A below 17%, and LA strain rate A above −1.7 s−1. After multivariate adjustment, the above-mentioned CMR markers remained associated with AF incidence: hazard ratio (95% confidence interval) 1.25 (1.06–1.48) and 1.51 (1.22–1.87) per 10 mL/m2 increase of LAmax and LAmin, respectively, 1.49 (1.26–1.76) and 1.46 CI (1.25–1.71) per 5% decrease in LA TEF and LA AEF, respectively, 1.23 (1.05–1.44) and 1.56 (1.18–2.06) per 5% decrease in LA strain S and A, respectively, and 2.06 (1.31–3.23) per s−1 increase in LA strain rate A. In prediction analyses, LA functional indices increased area under the receiver operating characteristic curve significantly. Conclusion The risk of AF, including asymptomatic AF, increases significantly with increasing LA volumes and worsening LA function.

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Schönbauer, Robert, Jakub Tomala, Bettina Kirstein, Yan Huo, Thomas Gaspar, Utz Richter, Judith Piorkowski, et al. "Left atrial phasic transport function closely correlates with fibrotic and arrhythmogenic atrial tissue degeneration in atrial fibrillation patients: cardiac magnetic resonance feature tracking and voltage mapping." EP Europace 23, no. 9 (March 9, 2021): 1400–1408. http://dx.doi.org/10.1093/europace/euab052.

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Abstract Aims To characterize the association of phasic left atrial (LA) transport function and LA fibrosis guided by multimodality imaging containing cardiac magnetic resonance imaging (CMR) feature tracking and bipolar voltage mapping. Methods and results Consecutive patients presenting for first-time ablation of atrial fibrillation (AF) were prospectively enrolled. Each patient underwent CMR prior to the ablation procedure. LA phasic indexed volumes (LA-Vi) and emptying fractions (LA-EF) were calculated and CMR feature tracking guided LA wall motion analysis was performed. LA bipolar voltage mapping was carried out in sinus rhythm to find areas of low voltage as a surrogate for fibrosis and arrhythmogenesis. One hundred and sixty-eight patients were enrolled. Low-voltage areas (LVAs) were present in 70 patients (42%). Contrary to LA volume, CMR based LA-EF [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80–0.96, P = 0.005] and LA booster pump strain rate (SR) (OR 0.98, 95% CI 0.97–0.99, P = 0.001) significantly predicted presence and extent of LVA in multivariate logistic regression analysis for patients scanned in SR. In receiver operating characteristic analysis, LA-EF <40% carried a sensitivity of 83% and specificity of 76% (area under the curve 0.8; 95% CI 0.71–0.89) to predict presence of LVA. For patients scanned in AF only minimal LA-Vi on CMR (OR: 1.06; 95% CI: 1.02–1.10; P = 0.002) predicted presence of LVA. Conclusion For patients scanned in SR LA-EF and LA booster pump SR are closely linked to the presence and extent of LA LVA.

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Quinto, Levio, Jenniffer Cozzari, Eva Benito, Francisco Alarcón, Felipe Bisbal, Omar Trotta, Gala Caixal, et al. "Magnetic resonance-guided re-ablation for atrial fibrillation is associated with a lower recurrence rate: a case–control study." EP Europace 22, no. 12 (October 16, 2020): 1805–11. http://dx.doi.org/10.1093/europace/euaa252.

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Abstract Aims Our aim was to analyse whether using delayed enhancement cardiac magnetic resonance imaging (DE-CMR) to localize veno-atrial gaps in atrial fibrillation (AF) redo ablation procedures improves outcomes during follow-up. Methods and results We conducted a case–control study with 35 consecutive patients undergoing a DE-CMR-guided Repeat-pulmonary vein isolation (Re-PVI) procedure. Those with more extensive ablations (e.g. roof lines, box) were excluded. Patients were matched for age, sex, AF pattern, and left atrial dimension with 35 patients who had undergone a conventional Re-PVI procedure guided with a three dimensional (3D)-navigation system. Procedural characteristics were recorded, and patients were followed for 24 months in a specialized outpatient clinic. The primary endpoint was freedom from recurrent AF, atrial tachycardia, or flutter. The duration of CMR-guided procedures was shorter compared to the conventional group (161 ± 52 vs. 195 ± 72 min, respectively, P = 0.049), with no significant differences in fluoroscopy or total radiofrequency time. At the 2-year follow-up, more patients in the DE-CMR-guided group remained free from recurrences compared with the conventional group (70% vs. 39%, respectively, P = 0.007). In univariate Cox-regression analyses, AF pattern [persistent AF, hazard ratio (HR) 2.66 (1.27–5.46), P = 0.006] and the use of DE-CMR [HR 0.36 (0.17–0.79), P = 0.009] predicted recurrences during follow-up; both factors remained independent predictors in multivariate analyses. Conclusion The substrate characterization provided by DE-CMR facilitates the identification of anatomical veno-atrial gaps and associates with shorter procedures and better clinical outcomes in repeated AF ablation procedures.

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Zaraket, Fatima, Deva Bas, Jesus Jimenez, Benjamin Casteigt, Begoña Benito, Julio Martí-Almor, Javi Conejos, Helena Tizón-Marcos, Diana Mojón, and Ermengol Vallès. "Cardiac Tomography and Cardiac Magnetic Resonance to Predict the Absence of Intracardiac Thrombus in Anticoagulated Patients Undergoing Atrial Fibrillation Ablation." Journal of Clinical Medicine 11, no. 8 (April 8, 2022): 2101. http://dx.doi.org/10.3390/jcm11082101.

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Background: Pulmonary veins isolation (PVI) is a standard treatment for recurrent atrial fibrillation (AF). Uninterrupted anticoagulation for a minimum of 3 weeks before ablation and exclusion of left atrial (LA) thrombus with transesophageal echography (TEE) immediately before or during the procedure minimize peri-procedural risk. We aimed to demonstrate the utility of cardiac tomography (CT) and cardiac magnetic resonance (CMR) to rule out LA thrombus prior to PVI. Methods: Patients undergoing PVI for recurrent AF were retrospectively evaluated. Only patients that started anticoagulation at least 3 weeks prior to the CT/CMR and subsequently uninterrupted until the ablation procedure were selected. An intracardiac echo (ICE) catheter was used in all patients to evaluate LA thrombus. The results of CT/CMR were compared to ICE imaging. Results: We included 272 consecutive patients averaging 54.5 years (71% male; 30% persistent AF). Average CHA2DS2VASC score was 0.9 ± 0.83 and mean LA diameter was 42 ± 5.7 mm, 111 (41%) patients were on Acenocumarol and 161 (59%) were on direct oral anticoagulants. Anticoagulation was started 227 ± 392 days before the CT/CMR, and 291 ± 416 days before the ablation procedure. CT/CMR diagnosed intracardiac thrombus in two cases, both in the LA appendage. A new CT/CMR revealed resolution of thrombus after six additional months of uninterrupted anticoagulation. No macroscopic thrombus was observed in any patients with ICE (negative predictive value of 100%; p < 0.01). Conclusions: CT and MRI are excellent surrogates to TEE and ICE to rule out intracardiac thrombus in patients adequately anticoagulated prior AF ablation. This is true even for delayed procedures as long as anticoagulation is uninterrupted.

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Kass-Hout, Omar, Tareq Kass-Hout, Ankit Parikh, Michael Hoskins, Stephen D. Clements, Srikant Rangaraju, Ali Reza Noorian, et al. "Atrial Fibrillation Predictors on Mobile Cardiac Telemetry in Cryptogenic Ischemic Stroke." Neurohospitalist 8, no. 1 (June 5, 2017): 7–11. http://dx.doi.org/10.1177/1941874417711761.

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Background and Purpose: The objective of our study was to evaluate magnetic resonance imaging (MRI) and echocardiographic characteristics that would identify patients with cryptogenic ischemic stroke (IS) and transient ischemic attack (TIA) who subsequently developed paroxysmal atrial fibrillation (PAF) on mobile cardiac outpatient telemetry (MCOT). Methods: All patients with cryptogenic IS or TIA seen at the Emory University Hospital and Emory University Hospital Midtown from January 1, 2009, to June 30, 2013, who underwent MCOT were included in this analysis. Location (cortical, high subcortical, or neither) of current and prior strokes on MRI and left atrial (LA) functional and anatomical echocardiographic parameters were evaluated to determine their association with subsequent detection of PAF. Results: Of 132 patients, 17 (13%) had evidence of newly diagnosed PAF on MCOT (mean duration of monitoring = 25 days). The presence (vs absence) of ≥1 cortical infarct on baseline MRI was a significant predictor of identifying PAF (odds ratio: 5.2, 95% confidence interval: 1.3-19; P = .01). On baseline echocardiography, patients who had PAF (vs non-PAF) had significantly higher mean LA diameters (4.2 vs 3.7 cm, P = .03) and lower tissue Doppler velocity (a’; 5.5 vs 13.5 cm/s, P = .03). In receiver operating characteristic analysis, the ratio of LA volume index to the septal Doppler velocity (LAVI/a’) of >4.6 was associated with a higher likelihood of PAF. Combining MRI with echocardiographic variables did not improve the predictive ability beyond echocardiography alone. Conclusion: Although the presence of cortical-based infarcts on MRI in patients with cryptogenic IS or TIA increases the likelihood of detecting PAF on MCOT, LA functional and anatomic parameters alone best predicted which patients subsequently had PAF.

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Manole, Simona, Claudia Budurea, Sorin Pop, Alin M. Iliescu, Cristiana A. Ciortea, Stefania D. Iancu, Loredana Popa, et al. "Correlation between Volumes Determined by Echocardiography and Cardiac MRI in Controls and Atrial Fibrillation Patients." Life 11, no. 12 (December 8, 2021): 1362. http://dx.doi.org/10.3390/life11121362.

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Aims: We aimed to compare cardiac volumes measured with echocardiography (echo) and cardiac magnetic resonance imaging (MRI) in a mixed cohort of healthy controls (controls) and patients with atrial fibrillation (AF). Materials and methods: In total, 123 subjects were included in our study; 99 full datasets were analyzed. All the participants underwent clinical evaluation, EKG, echo, and cardiac MRI acquisition. Participants with full clinical data were grouped into 63 AF patients and 36 controls for calculation of left atrial volume (LA Vol) and 51 AF patients and 30 controls for calculation of left ventricular end-diastolic volume (LV EDV), end-systolic volume (ESV), and LV ejection fraction (LV EF). Results: No significant differences in LA Vol were observed (p > 0.05) when measured by either echo or MRI. However, echo provided significantly lower values for left ventricular volume (p < 0.0001). The echo LA Vol of all the subjects correlated well with that measured by MRI (Spearmen correlation coefficient r = 0.83, p < 0.0001). When comparing the two methods, significant positive correlations of EDV (all subjects: r = 0.55; Controls: r = 0.71; and AF patients: r = 0.51) and ESV (all subjects: r = 0.62; Controls: r = 0.47; and AF patients: r = 0.66) were found, with a negative bias for values determined using echo. For a subgroup of participants with ventricular volumes smaller than 49.50 mL, this bias was missing, thus in this case echocardiography could be used as an alternative for MRI. Conclusion: Good correlation and reduced bias were observed for LA Vol and EF determined by echo as compared to cardiac MRI in a mixed cohort of patients with AF and healthy volunteers. For the determination of volume values below 49.50 mL, an excellent correlation was observed between values obtained using echo and MRI, with comparatively reduced bias for the volumes determined by echo. Therefore, in certain cases, echocardiography could be used as a less expensive, less time-consuming, and contraindication free alternative to MRI for cardiac volume determination.

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Italiano, Gianpiero, Gloria Tamborini, Laura Fusini, Valentina Mantegazza, Marco Doldi, Fabrizio Celeste, Paola Gripari, Manuela Muratori, Roberto M. Lang, and Mauro Pepi. "Feasibility and Accuracy of the Automated Software for Dynamic Quantification of Left Ventricular and Atrial Volumes and Function in a Large Unselected Population." Journal of Clinical Medicine 10, no. 21 (October 28, 2021): 5030. http://dx.doi.org/10.3390/jcm10215030.

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We aimed to evaluate the feasibility and accuracy of machine learning-based automated dynamic quantification of left ventricular (LV) and left atrial (LA) volumes in an unselected population. We enrolled 600 unselected patients (12% in atrial fibrillation) clinically referred for transthoracic echocardiography (2DTTE), who also underwent 3D echocardiography (3DE) imaging. LV ejection fraction (EF), LV, and LA volumes were obtained from 2D images; 3D images were analyzed using dynamic heart model (DHM) software (Philips) resulting in LV and LA volume–time curves. A subgroup of 140 patients also underwent cardiac magnetic resonance (CMR) imaging. Average time of analysis, feasibility, and image quality were recorded, and results were compared between 2DTTE, DHM, and CMR. The use of DHM was feasible in 522/600 cases (87%). When feasible, the boundary position was considered accurate in 335/522 patients (64%), while major (n = 38) or minor (n = 149) border corrections were needed. The overall time required for DHM datasets was approximately 40 seconds. As expected, DHM LV volumes were larger than 2D ones (end-diastolic volume: 173 ± 64 vs. 142 ± 58 mL, respectively), while no differences were found for LV EF and LA volumes (EF: 55% ± 12 vs. 56% ± 14; LA volume 89 ± 36 vs. 89 ± 38 mL, respectively). The comparison between DHM and CMR values showed a high correlation for LV volumes (r = 0.70 and r = 0.82, p < 0.001 for end-diastolic and end-systolic volume, respectively) and an excellent correlation for EF (r = 0.82, p < 0.001) and LA volumes. The DHM software is feasible, accurate, and quick in a large series of unselected patients, including those with suboptimal 2D images or in atrial fibrillation.

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Lutomsky, B. A., T. Rostock, A. Koops, D. Steven, K. Mullerleile, H. Servatius, I. Drewitz, et al. "Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging." Europace 10, no. 5 (April 7, 2008): 593–99. http://dx.doi.org/10.1093/europace/eun076.

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Quintana, Raymundo A., Tiffany Dong, Ramya Vajapey, Reza Reyaldeen, Deborah H. Kwon, Serge Harb, Tom Kai Ming Wang, and Allan L. Klein. "Preprocedural Multimodality Imaging in Atrial Fibrillation." Circulation: Cardiovascular Imaging 15, no. 10 (October 2022). http://dx.doi.org/10.1161/circimaging.122.014386.

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Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased risk of heart failure, stroke, and death. In current medical practice, multimodality imaging is routinely used in the management of AF. Twenty-one years ago, the ACUTE trial (Assessment of Cardioversion Using Transesophageal Echocardiography) results were published, and the management of AF changed forever by incorporating transesophageal echocardiography guided cardioversion of patients in AF for the first time. Current applications of multimodality imaging in AF in 2022 include the use of transesophageal echocardiography and computed tomography before cardioversion to exclude left atrial thrombus and in left atrial appendage occlusion device implantation. Transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance are clinically used for AF ablation planning. The decision to use a particular imaging modality in AF is based on patient’s characteristics, guideline recommendation, institutional preferences, expertise, and cost. In this first of 2-part review series, we discuss the preprocedural role of echocardiography, computed tomography, and cardiac magnetic resonance in the AF, with regard to their clinical applications, relevant outcomes data and unmet needs, and highlights future directions in this rapidly evolving field.

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Agoston Vas Coldea, L. N., P. Vrancianu, A. Tutu, R. Agoston, I. Muresan, and T. Mocan. "P1341 An old patient with two tales: left cor triatriatum and atrial septal defect." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.779.

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Abstract Introduction Cor triatriatum sinistrum is a rare congenital condition, diagnosed in 0.4% of cases at autopsy, in which the left atrium is divided in two chambers by a fibromuscular membrane. In 80% of the cases it is associated with other cardiac abnormalities, the most common being ostium secundum atrial septal defect. Case report A 71-year-old man with a history of congestive heart failure was admitted to the hospital for dyspnoea, fatigue and ankle swelling. The physical examination revealed jaundice, severe pretibial oedema, bibasal crackles, irregular heart sounds, a 3/6 mitral and tricuspid systolic murmur, jugular vein distension, hepatomegaly. Electrocardiographical findings included atrial fibrillation and right bundle branch block. Transthoracic echocardiography showed severely enlarged right cavities, an ostium secundum atrial septal defect of 23 mm with right to left shunt, a dilated left atrium divided by a membrane and severe pulmonary arterial hypertension. Cardiac magnetic resonance imaging revealed nodular late gadolinium enhancement (LGE) areas and confirmed ostium secundum atrial septal defect and also a fibromuscular membrane, dividing the left atrium into a proximal and distal chamber. Despite appropriate therapy, the patient’s clinical state altered in the following days and he eventually died, due to ventricular fibrillation. The autopsy confirmed the ostium secundum atrial septal defect and the cor triatriatum sinister and also revealed an abnormal emergence of the circumflex artery from the left coronary sinus (Figure). Conclusion Cor triatriatum sinistrum and also ostium secundum atrial septal defect are rare abnormalities usually recognized early in lifetime due to unspecified symptoms of heart failure. In adults it can become symptomatic later in time, like in our case, with the development of multiple associated conditions: atrial fibrillation, pulmonary hypertension, left ventricle dysfunction, with a poor prognosis. Abstract P1341 Figure

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Quintana, Raymundo A., Tiffany Dong, Ramya Vajapey, Reza Reyaldeen, Deborah H. Kwon, Serge Harb, Tom Kai Ming Wang, and Allan L. Klein. "Intra- and Postprocedural Multimodality Imaging in Atrial Fibrillation." Circulation: Cardiovascular Imaging 15, no. 11 (November 2022). http://dx.doi.org/10.1161/circimaging.122.014804.

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Multi-modality imaging plays critical roles during and after procedures associated with atrial fibrillation. Transesophageal echocardiography is an invaluable tool for left atrial appendage occlusion during the procedure and at follow-up. Both cardiac computed tomography and cardiac magnetic resonance contribute to postprocedural evaluation of pulmonary vein isolation ablation. The present review is the second of a 2-part series where we discuss the roles of cardiac imaging in the evaluation and management of patients with atrial fibrillation, focusing on intraprocedural and postprocedural assessment, including the clinical evidence and outcomes data supporting this future applications.

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Lang, Roberto M., Matteo Cameli, Leila E. Sade, Francesco F. Faletra, Federico Fortuni, Alexia Rossi, and Laurie Soulat-Dufour. "Imaging assessment of the right atrium: anatomy and function." European Heart Journal - Cardiovascular Imaging, January 25, 2022. http://dx.doi.org/10.1093/ehjci/jeac011.

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Abstract The right atrium (RA) is the cardiac chamber that has been least well studied. Due to recent advances in interventional cardiology, the need for greater understanding of the RA anatomy and physiology has garnered significant attention. In this article, we review how a comprehensive assessment of RA dimensions and function using either echocardiography, cardiac computed tomography, and magnetic resonance imaging may be used as a first step towards a better understanding of RA pathophysiology. The recently published normative data on RA size and function will likely shed light on RA atrial remodelling in atrial fibrillation (AF), which is a complex phenomenon that occurs in both atria but has only been studied in depth in the left atrium. Changes in RA structure and function have prognostic implications in pulmonary hypertension (PH), where the increased right ventricular (RV) afterload first induces RV remodelling, predominantly characterized by hypertrophy. As PH progresses, RV dysfunction and dilatation may begin and eventually lead to RV failure. Thereafter, RV overload and increased RV stiffness may lead to a proportional increase in RA pressure. This manuscript provides an in-depth review of RA anatomy, function, and haemodynamics with particular emphasis on the changes in structure and function that occur in AF, tricuspid regurgitation, and PH.

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Rettmann, Maryam E., David R. Holmes, Kristi H. Monahan, Jerome F. Breen, Tristram D. Bahnson, Daniel B. Mark, Jeanne E. Poole, et al. "Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings From the CABANA Imaging Substudy." Circulation: Arrhythmia and Electrophysiology 14, no. 5 (May 2021). http://dx.doi.org/10.1161/circep.120.008540.

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Background: The CABANA trial (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) was a randomized, prospective trial of left atrial catheter ablation versus drug therapy for treatment of atrial fibrillation (AF). As part of CABANA, a prospective imaging substudy was conducted. The main objectives were to describe the patterns of changes in the dimensions of the left atrium and pulmonary veins (PVs), and the relationship between these changes with treatment assignment and clinical outcomes. Methods: Computed tomography or magnetic resonance imaging was acquired at baseline and follow-up in 121 ablation (median follow-up 101 days) and 85 drug patients (median follow-up 97 days). Left atrial volume index, mean PV ostial diameter, and ostial diameters of each PV separately were computed. We examined the relationship between the change from baseline to follow-up with subsequent clinical outcomes (composite of death, disabling stroke, serious bleeding, or cardiac arrest [CABANA primary end point], total mortality or cardiovascular hospitalization, first AF recurrence after the 90-day blanking period, first AF/atrial flutter/atrial tachycardia after the 90-day blanking period) using Cox proportional-hazards models. Results: The median (25th to 75th) change from baseline for left atrial volume index was −7.8 mL/m 2 (−16.4 to 0.2), ablation arm and −3.5 mL/m 2 (−11.4 to 2.6), drug therapy arm. The left atrial volume index decreased in 52.9% of ablation patients versus 40.0% of drug therapy patients. Change for mean PV was −2.7 mm (−4.2 to −1.3) in the ablation arm versus −0.1 mm (−1.5 to 0.8) in the drug therapy arm. Changes in left atrium and PV dimensions had no consistent relationship with the risk of developing the study primary end point. Reductions in left atrial volume index, and in mean PV diameter were associated with decreased risk of AF recurrence. Conclusions: Ablation patients demonstrated more frequent and larger atrial structural changes compared with drug patients. These changes suggest a critical relationship between structural features and AF generation.

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Moniz Mendonca, F. V., J. A. S. Sousa, J. M. Monteiro, M. R. Mraquel, M. N. Neto, G. C. Caires, and D. F. Freitas. "P1242 Giant right atrium aneurysm presenting as right heart failure." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.696.

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Abstract Introduction Idiopathic aneurysmal dilatations of the right atrium are rare anomalies. It can be diagnosed at any time between foetal and adult life. This exceptional condition can be confused with other conditions that involve enlargement of right atrium. We report a clinical case of a symptomatic adult who was diagnosed with giant right atrium aneurysm. Case report An 83-year-old female presented with complaints of fatigue, paroxysmal nocturnal dyspnoea, exertional dyspnoea, orthopnoea and cough since last week. There were no history of syncope, convulsions or evidence of thromboembolism. There were a medical history of diverticulosis and atrial fibrillation (warfarin therapy). The principal findings on physical examination included holosystolic murmur at the left middle sternal border, pulmonary rales, jugular venous distension, enlarged liver and peripheral oedema. An electrocardiogram showed an atrial fibrillation with a controlled heart rate response, right axis deviation, right bundle-branch block. A chest radiography posteroanterior view showed a markedly enlarged cardiac silhouette, increased pulmonary vascular congestion, and bilateral pleural effusions. Computed tomography (CT) scan showed aneurysmal dilated right atrium communicating with right ventricle. Right ventricle (RV) and RV outflow tract were dilated with normal pulmonary arteries. Two-dimensional transthoracic echocardiography revealed aneurysmal dilated right atrium measuring 398mL/m2. The tricuspid valve was no displaced. There was severe tricuspid regurgitation and no stenosis. The right atrium was kinetic without any intracavitary thrombus. The intertrial and interventricular septa were intact. The right ventricle and outflow tract were mildly dilated with preserved systolic function. The left atrium and left ventricle were normal. The patient was admitted to the cardiology department with the diagnosis of right heart failure. Conclusion Aneurysm of right atrium is an uncommon condition. It is diagnosed as a disproportionately enlarged right atrium compared to the other cardiac chambers in the absence of other cardiac or hemodynamic abnormalities and must be distinguished from other anomalies causing structural pathology of the right atrium. Approximately, one-half of the patients have no symptoms. Others presented with arrhythmia, palpitations, chest pain, shortness of breath, and fatigue. The major rhythm abnormality is atrial fibrillation or atrial flutter. Our patient presented with symptoms of right heart failure and atrial fibrillation. The right enlargement is usually associated with tricuspid annular dilatation responsible for functional regurgitation, which can be severe in some cases. The diagnosis of right atrium malformation can be established by echocardiography, CT or magnetic resonance imaging. Literature reports various ways to manage these patients. Treatment ranges from conservative to surgical resection specially in the presence of arrhythmias. Abstract P1242 Figure. Aneurysm of right atrium

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Saraiva, M., A. Moura, N. Craveiro, M. J. Vieira, J. Abecassis, M. L. Pitta, and V. Martins. "P887 Two sides of the same mass." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.527.

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Abstract Echocardiography (echo) remains the first-line imaging modality for the evaluation of cardiac masses. Three-dimensional (3D) echo, either transthoracic or transesophageal (TTE and TEE respectively), has allowed for better definition imaging, providing more information about the size, mobility, attachment and relation of these lesions with cardiac structures. Nevertheless, due to its superior tissue characterization capability, other imaging techniques, such as cardiac magnetic resonance (CMR), are very helpful in the differential diagnosis, making multimodality imaging the most attractive option for the study of intracardiac masses. We present the case of a 85 year-old male, with paroxysmal atrial fibrillation (under effective anticoagulation), type 2 diabetes mellitus, hypertension, referred for the study of an asymptomatic cardiac mass found in a routine TTE. There were no relevant findings on physical examination. The TTE showed a bilobar spheroid mass, in the right atrium, attached to the interatrial septum, with 33x23mm and regular edges. A 3D TEE was performed confirming the previous findings, but also showing extension of this mass through the fossa ovalis membrane, reaching the left atrium; this aspect raised the doubt about either protrusion or invasion of the left atrium and, respectively, a benign (like a myxoma) versus malignant behaviour (such as a sarcoma). To better characterize this lesion, a CMR was ordered, which revealed a bilobar heterogeneous mass, attached to the right side of the interatrial septum, at the fossa ovalis membrane, without signs of adjacent tissue invasion, namely unequivocal invasion of the left atrium; it presented with intermediate T1 signal, hyperintense T2 signal and heterogeneous pattern of gadolinium enhancement, features mostly in favour of a right atrial myxoma. The complimentary study found no other relevant changes, namely no findings suggestive of endocarditis (negative blood cultures), autoimmune disease or malignancy. The patient refused undergoing heart surgery and, therefore, kept follow-up with clinical and echocardiographic stability. Although histological examination remains the only tool for definitive diagnosis, multimodality imaging allows a quite comprehensive evaluation of intracardiac masses, enlightening the differential diagnosis. Here the imaging findings helped to establish a benign origin as the most likely, very important in this case of a probable right atrial myxoma, due to its peculiar protrusion to the left atrium through the fossa ovalis membrane. Abstract P887 Figure. atrial myxoma

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Mandoli, Giulia Elena, Flavio D'Ascenzi, Giulia Vinco, Giovanni Benfari, Fabrizio Ricci, Marta Focardi, Luna Cavigli, et al. "Novel Approaches in Cardiac Imaging for Non-invasive Assessment of Left Heart Myocardial Fibrosis." Frontiers in Cardiovascular Medicine 8 (April 15, 2021). http://dx.doi.org/10.3389/fcvm.2021.614235.

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In the past, the identification of myocardial fibrosis was only possible through invasive histologic assessment. Although endomyocardial biopsy remains the gold standard, recent advances in cardiac imaging techniques have enabled non-invasive tissue characterization of the myocardium, which has also provided valuable insights into specific disease processes. The diagnostic accuracy, incremental yield and prognostic value of speckle tracking echocardiography, late gadolinium enhancement and parametric mapping modules by cardiac magnetic resonance and cardiac computed tomography have been validated against tissue samples and tested in broad patient populations, overall providing relevant clinical information to the cardiologist. This review describes the patterns of left ventricular and left atrial fibrosis, and their characterization by advanced echocardiography, cardiac magnetic resonance and cardiac computed tomography, allowing for clinical applications in sudden cardiac death and management of atrial fibrillation.

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Pires, Carla Marques, Rita Silva, Bárbara Lage Garcia, Nuno Antunes, Catarina Vieira, Jorge Marques, Sandro Queirós, and Vitor Hugo Pereira. "Atrial cardiopathy in young adults with embolic stroke of undetermined source: a myocardial deformation imaging analysis." International Journal of Cardiovascular Imaging, December 21, 2022. http://dx.doi.org/10.1007/s10554-022-02779-6.

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Abstract Background Atrial cardiopathy (AC) has emerged as a potential pathological thrombogenic atrial substract of embolic stroke of undetermined source (ESUS), even in the absence of atrial fibrillation. Left atrium (LA) myocardial deformation analysis may be of value as a subclinical marker of AC and a predictor of ESUS. Aims To compare LA mechanical function between ESUS cases and age and sex-matched controls. Methods A single-center analytical study with case-control design was performed. Case group was composed by young patients admitted in the Neurology department from January 2017 to June 2021. Control group was composed by age and sex matched controls recruited from the community. All participants performed echocardiogram and a smaller sample underwent cardiac magnetic resonance. Results We recruited 31 ESUS patients aged between 18 and 65 years and 31 age and sex matched controls. ESUS patients had a significantly higher prevalence of cardiovascular risk factors and patent foramen ovale (PFO). The prevalence of AC was not different between groups. Echocardiogram parameters, including strain analysis, were similar between groups, except for LA appendage (LAA) ostium variation which was significantly lower in ESUS patients (absolute: 6.5vs8.7mm, p<0.001; relative: 44.5%vs53.4%, p=0.002). After exclusion of patients with PFO, all the results were statistically similar. Regarding cardiac magnetic resonance analysis, there were no statistically significant differences between groups. Conclusion This study shows that in our population atria cardiopathy and atrial function was not associated with ESUS.LAA structural and functional abnormalities may play a major role. The role of LAA in ESUS warrants further studies.

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Kheirkhahan, Mobin, Alex Baher, Johannes Siebermair, Gagandeep Kaur, Benjamin A. Steinberg, Frederick T. Han, Mihail G. Chelu, and Nassir F. Marrouche. "Abstract 21031: Paroxysmal Supraventricular Tachycardia is Associated With Atrial Enhancement Detected With Late Gadolinium Enhanced MRI." Circulation 136, suppl_1 (November 14, 2017). http://dx.doi.org/10.1161/circ.136.suppl_1.21031.

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Introduction: Paroxysmal supraventricular tachycardias (PSVT) are among common cardiac arrhythmias. Atrial fibrosis correlates with several cardiac dysrhythmias and while its role is well described in atrial fibrillation, its role in PSVTs is less clear. We sought to investigate the extent of left atrial (LA) and right atrial (RA) enhancement in patients with supraventricular tachycardia (SVT) without a history of atrial fibrillation. Methods and Results: In our case-control study the information of 212 patients was collected. 30 patients with PSVT (age 48.6 ± 20.1 and 43% male) and 182 patients with no known arrhythmic disorder as the control group (age 50.3 ± 14.7 and 66% males) matched for age, LA volume, left ventricular ejection fraction (LVEF) and other comorbidities such as hypertension, hyperlipidemia, diabetes, coronary artery disease, heart failure, and smoking. LA and RA fibrosis were quantified by the Late Gadolinium Enhanced Magnetic Resonance Imaging (LGE-MRI) using signal intensity analysis. The average % LA wall enhancements were 15.2% ± 6.3% in the SVT group and 10.7% ± 6.5% in the control group (p = 0.001) while for RA enhancement they were 11.1% ± 5% and 8.1% ± 4.1% for the SVT and control groups respectively (p = 0.009). Our logistic regression analysis showed that for each 1% increase in LA and RA enhancement, there was a 19% and 16% greater chance of having PSVT (p = 0.006, p = 0.013 respectively). Conclusions: Our study suggests that the extent of atrial fibrosis (either in the left or right atrium), quantified using LGE-MRI, is higher among patients with PSVT. The impact of increased atrial fibrosis in this patient population, could be correlated with other major adverse cardiac events.

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Rios-Munoz, G., C. Perez-Hernandez, F. Fernandez-Aviles, and A. Arenal. "Atrial chamber colocalization for multiple 3D imaging techniques in atrial fibrillation." European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.0486.

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Abstract Introduction There exist many imaging techniques and systems to reproduce atrial chambers in 3D. These technologies include electroanatomical (EA) mapping systems, noninvasive electrocardiographic imaging (ECGI), magnetic resonance imaging (MRI), or computed tomography (CT) scans. In the case of atrial fibrillation (AF), the most employed non-pharmacological treatment is catheter ablation to electrically isolate the pulmonary veins from the rest of the left atrium. Driver mechanisms such as focal or rotational activity have been proposed as possible initiating and maintaining mechanisms of AF. However, correspondence and validation of these sites when several systems are employed in the same patient remains a challenge, as they are mostly manually aligned based on visual inspection. Purpose To develop an automatic 3D alignment algorithm for cardiac 3D meshes to colocalize points between atrial maps generated with multiple EA mapping systems, ECGI, MRI, or CT scans. Methods A total of 25 left atrial meshes from persistent AF patients were exported from an EA mapping system. The total number of vertices for all the meshes was 2545444 points (101817.8±13593.3 points per map). A reference mesh was employed with minor modifications [1]. All meshes were manually segmented into 12 different left atrial regions, see Table for the region names. The method implements a non-rigid variant of the iterative closest point algorithm to transform the atrial mesh onto the reference one, see Figure. The geographical distance between the mean position of the 12 different segmented reference areas and the 12 transformed points was employed as the performance metric. Results The global error for all the fiducial points in all left atrial meshes was 11.57±2.55 mm. The average local errors for the 12 atrial areas are summarized in the Table. The best three aligned areas were the RSPV, atrial septum, and lateral wall. The areas with less alignment accuracy were the LAA, LSPV, and atrial roof. Conclusions The algorithm provides a promising solution to evaluate and validate site-related results from different systems, e.g., rotational activity presence between EA mapping and ECGI systems. The method works automatically for any given chamber anatomy or any number of points. No prior segmentation is needed since the transformation and co-localization are applied to the raw chamber mesh. Further analysis with a larger mesh database is needed. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III and Ministerio de Ciencia, Innovaciόn y Universidades

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Shahawy, H., A. Al Agha, and M. Helmy. "Comparative study of cardiac magnetic resonance imaging and transesophageal echocardiography in detection of left atrial and left atrial appendage thrombi." European Heart Journal - Cardiovascular Imaging 22, Supplement_2 (June 1, 2021). http://dx.doi.org/10.1093/ehjci/jeab090.034.

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Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial (LA) thrombi are the most common intracardiac masses. Left atrial appendage (LAA) is the most common site for thrombus formation in patients with atrial fibrillation (AF), and in patients with valvular lesions. Transesophageal echocardiography (TEE) has been the conventional investigation for thrombus detection. However, because TEE is a semi-invasive technique; a completely non-invasive technique would be of great concern. Purpose The aim of this study is to evaluate the feasibility and diagnostic performance of cardiac magnetic resonance imaging (CMR), for the assessment of thrombi in the left atrium and left atrial appendage (LA/ LAA). Also whether CMR is comparable to TEE in identification and measurement of thrombus size. Methods We studied 43 patients who were diagnosed to have LA/LAA thrombus, or highly suspected thrombus by TEE. They underwent multisequence CMR for assessment of thrombus detection; within 7 days of TEE performance. Data collected from CMR study were statistically analyzed to evaluate for sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and overall accuracy of detection of LA/LAA thrombus using TEE as the gold standard. Also agreement between both imaging techniques was assessed using kappa agreement coefficient. We conducted a questionnaire where 10 questions were asked to every patient in the study. It aimed to obtain an idea about patients’ opinion of both tests. Results During the study period of 13 months, 43 patients were assessed. Twenty one patients had AF and 22 patients were in sinus rhythm. The median CHA2DS2VASc score of AF patients was 2.52 ± 1.12, and 76.7% of patients were undergoing anticoagulation therapy. In all subjects, the LAA was readily visualized with CMR. When evaluating the diagnostic performance of CMR results revealed overall sensitivity, specificity, PPV, NPV and accuracy of 97.44%, 75%, 97.44%, 75% and 95.35% respectively. Results of questionnaire was statistically significant p value yielding good overall opinion for the sake of CMR. There was an additional role for CMR regarding tissue characterization; where CMR detected 3 cases, diagnosed by TEE as thrombus, 1 case revealed Libman-Sacks Endocarditis and 2 cases revealed fibroelastoma. This made a paradigm shift in patient management. Conclusion CMR is a noninvasive, feasible and comparable modality for thrombus detection in the LA and LAA and could be a reasonable, more comfortable alternative to TEE.

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Gray, R., J. Brassil, and N. Jepson. "P1699 A case of atrial myxoma presenting with acute stroke." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.1062.

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Abstract A 73-year-old female presented with sudden reduced level of consciousness on the background of rheumatoid arthritis and dyslipidaemia. On examination she had a Glascow Coma Score of 12 and an irregularly irregular pulse. The electrocardiograph confirmed atrial fibrillation and showed widespread T wave inversion. A computed tomography cerebral angiogram showed an acute basilar artery occlusion. She was transferred to a tertiary centre where she had successful endovascular clot retrieval. An urgent transthoracic echocardiogram (figure 1) showed apical hypertrophy, normal systolic function and a large right atrial mass. The left atrial size was normal. A transoesophageal echocardiogram (figure 3) confirmed a large pedunculated mobile mass with a hypermobile septum consistent with a patent foramen ovale. There was no right to left doppler flow, however the atrial mass obstructed the course, and a bubble study was positive. The cardiac magnetic resonance image (figure 2) showed a 47 x 48 mm pedunculated lesion within the right atrium, arising from the intraventricular septum, demonstrating moderate T2 signal intensity, and intermediate T1 signal intensity, with avid enhancement, consistent with a right atrial myxoma. There was increased apical wall thickening at 15mm which confirmed apical hypertrophic cardiomyopathy. An open surgical resection and left atrial appendage ligation was performed on day 11 of admission. Histopathology confirmed an atrial myxoma. She had an excellent neurological recovery with only mild diplopia. The mechanism of stroke was likely atrial fibrillation secondary to increased left atrial pressure from apical hypertrophic cardiomyopathy. However, the unexpected finding of a right atrial myxoma with a corresponding patent foramen ovale provides a second possible mechanism. Abstract P1699 Figure. Right atrial Myxoma

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Journal articles on the topic 'Left atrium; atrial fibrillation; cardiac magnetic resonance imaging'

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