The association of baseline left atrial structure and function measured with cardiac magnetic resonance and pulmonary vein isolation outcome in patients with drug-refractory atrial fibrillation

Mohammadali Habibi, Joao Lima, Esra Gucuk Ipek, Stefan Zimmerman, Vadim Zipunnikov, David D Spragg, Hiroshi Ashikaga, John Rickard, Joseph Marine, Ronald D Berger, Hugh Calkins, Saman Nazarian

Research output: Contribution to journalArticle

Abstract

Background: Prognostic significance of left atrial (LA) function in patients with atrial fibrillation (AF) is poorly defined. Objective: To examine the association of LA function measured with cardiac magnetic resonance (CMR) feature-tracking and AF recurrence following catheter ablation. Methods: One hundred and twenty-one AF patients (72% paroxysmal, mean age 59 ± 10 years) were enrolled. Baseline LA function was measured by calculating passive, active, and total emptying fractions (LAEF) and analysis of global longitudinal strain and strain rates. Patients were followed up for recurrence of AF or atrial tachycardia (AT). Hazard ratios for recurrence were calculated using Cox proportional models adjusted for potential clinical confounders, type of AF, left ventricular ejection fraction, AF duration, LA volume, and late gadolinium enhancement (LGE). Results: During a mean follow-up of 18 ± 9 months, 52 patients (43%) experienced recurrent AF/AT. Patients with recurrent AF/AT had higher baseline LA volume index and lower LA passive, and total LAEF (P <.05 for all). The baseline peak LA strain and strain rates in all phases of LA function were lower in the AF/AT recurrence group (P <.01 for all). In multivariable analysis total LAEF, peak LA strain, and systolic and late diastolic strain rates were associated with recurrence. Both peak LA strain and total LAEF improved prediction of recurrent AT/AF compared to the baseline clinical model, including LA LGE (C statistic 0.82 vs 0.77, P <.05 for both total LAEF and peak LA strain). Conclusions: LA reservoir function was independently associated with recurrent AF/AT after PVI and can additionally improve risk stratification in patients undergoing PVI.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2016

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Left Atrial Function
Pulmonary Veins
Atrial Fibrillation
Magnetic Resonance Spectroscopy
Tachycardia
Pharmaceutical Preparations
Recurrence
Gadolinium
Catheter Ablation
Proportional Hazards Models
Stroke Volume

Keywords

  • Cardiac MRI
  • Left atrial fibrosis
  • Left atrial function
  • Pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{60aba90532e04f2c9826f03a0cad0fe4,
title = "The association of baseline left atrial structure and function measured with cardiac magnetic resonance and pulmonary vein isolation outcome in patients with drug-refractory atrial fibrillation",
abstract = "Background: Prognostic significance of left atrial (LA) function in patients with atrial fibrillation (AF) is poorly defined. Objective: To examine the association of LA function measured with cardiac magnetic resonance (CMR) feature-tracking and AF recurrence following catheter ablation. Methods: One hundred and twenty-one AF patients (72{\%} paroxysmal, mean age 59 ± 10 years) were enrolled. Baseline LA function was measured by calculating passive, active, and total emptying fractions (LAEF) and analysis of global longitudinal strain and strain rates. Patients were followed up for recurrence of AF or atrial tachycardia (AT). Hazard ratios for recurrence were calculated using Cox proportional models adjusted for potential clinical confounders, type of AF, left ventricular ejection fraction, AF duration, LA volume, and late gadolinium enhancement (LGE). Results: During a mean follow-up of 18 ± 9 months, 52 patients (43{\%}) experienced recurrent AF/AT. Patients with recurrent AF/AT had higher baseline LA volume index and lower LA passive, and total LAEF (P <.05 for all). The baseline peak LA strain and strain rates in all phases of LA function were lower in the AF/AT recurrence group (P <.01 for all). In multivariable analysis total LAEF, peak LA strain, and systolic and late diastolic strain rates were associated with recurrence. Both peak LA strain and total LAEF improved prediction of recurrent AT/AF compared to the baseline clinical model, including LA LGE (C statistic 0.82 vs 0.77, P <.05 for both total LAEF and peak LA strain). Conclusions: LA reservoir function was independently associated with recurrent AF/AT after PVI and can additionally improve risk stratification in patients undergoing PVI.",
keywords = "Cardiac MRI, Left atrial fibrosis, Left atrial function, Pulmonary vein isolation",
author = "Mohammadali Habibi and Joao Lima and {Gucuk Ipek}, Esra and Stefan Zimmerman and Vadim Zipunnikov and Spragg, {David D} and Hiroshi Ashikaga and John Rickard and Joseph Marine and Berger, {Ronald D} and Hugh Calkins and Saman Nazarian",
year = "2016",
doi = "10.1016/j.hrthm.2016.01.016",
language = "English (US)",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",

}

TY - JOUR

T1 - The association of baseline left atrial structure and function measured with cardiac magnetic resonance and pulmonary vein isolation outcome in patients with drug-refractory atrial fibrillation

AU - Habibi, Mohammadali

AU - Lima, Joao

AU - Gucuk Ipek, Esra

AU - Zimmerman, Stefan

AU - Zipunnikov, Vadim

AU - Spragg, David D

AU - Ashikaga, Hiroshi

AU - Rickard, John

AU - Marine, Joseph

AU - Berger, Ronald D

AU - Calkins, Hugh

AU - Nazarian, Saman

PY - 2016

Y1 - 2016

N2 - Background: Prognostic significance of left atrial (LA) function in patients with atrial fibrillation (AF) is poorly defined. Objective: To examine the association of LA function measured with cardiac magnetic resonance (CMR) feature-tracking and AF recurrence following catheter ablation. Methods: One hundred and twenty-one AF patients (72% paroxysmal, mean age 59 ± 10 years) were enrolled. Baseline LA function was measured by calculating passive, active, and total emptying fractions (LAEF) and analysis of global longitudinal strain and strain rates. Patients were followed up for recurrence of AF or atrial tachycardia (AT). Hazard ratios for recurrence were calculated using Cox proportional models adjusted for potential clinical confounders, type of AF, left ventricular ejection fraction, AF duration, LA volume, and late gadolinium enhancement (LGE). Results: During a mean follow-up of 18 ± 9 months, 52 patients (43%) experienced recurrent AF/AT. Patients with recurrent AF/AT had higher baseline LA volume index and lower LA passive, and total LAEF (P <.05 for all). The baseline peak LA strain and strain rates in all phases of LA function were lower in the AF/AT recurrence group (P <.01 for all). In multivariable analysis total LAEF, peak LA strain, and systolic and late diastolic strain rates were associated with recurrence. Both peak LA strain and total LAEF improved prediction of recurrent AT/AF compared to the baseline clinical model, including LA LGE (C statistic 0.82 vs 0.77, P <.05 for both total LAEF and peak LA strain). Conclusions: LA reservoir function was independently associated with recurrent AF/AT after PVI and can additionally improve risk stratification in patients undergoing PVI.

AB - Background: Prognostic significance of left atrial (LA) function in patients with atrial fibrillation (AF) is poorly defined. Objective: To examine the association of LA function measured with cardiac magnetic resonance (CMR) feature-tracking and AF recurrence following catheter ablation. Methods: One hundred and twenty-one AF patients (72% paroxysmal, mean age 59 ± 10 years) were enrolled. Baseline LA function was measured by calculating passive, active, and total emptying fractions (LAEF) and analysis of global longitudinal strain and strain rates. Patients were followed up for recurrence of AF or atrial tachycardia (AT). Hazard ratios for recurrence were calculated using Cox proportional models adjusted for potential clinical confounders, type of AF, left ventricular ejection fraction, AF duration, LA volume, and late gadolinium enhancement (LGE). Results: During a mean follow-up of 18 ± 9 months, 52 patients (43%) experienced recurrent AF/AT. Patients with recurrent AF/AT had higher baseline LA volume index and lower LA passive, and total LAEF (P <.05 for all). The baseline peak LA strain and strain rates in all phases of LA function were lower in the AF/AT recurrence group (P <.01 for all). In multivariable analysis total LAEF, peak LA strain, and systolic and late diastolic strain rates were associated with recurrence. Both peak LA strain and total LAEF improved prediction of recurrent AT/AF compared to the baseline clinical model, including LA LGE (C statistic 0.82 vs 0.77, P <.05 for both total LAEF and peak LA strain). Conclusions: LA reservoir function was independently associated with recurrent AF/AT after PVI and can additionally improve risk stratification in patients undergoing PVI.

KW - Cardiac MRI

KW - Left atrial fibrosis

KW - Left atrial function

KW - Pulmonary vein isolation

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U2 - 10.1016/j.hrthm.2016.01.016

DO - 10.1016/j.hrthm.2016.01.016

M3 - Article

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

ER -