Key result
AF linked to ~30% greater LA stasis on 4D flow vs healthy volunteers.
Why the study?
LA 4D flow quantification and strain may help predict stroke and thrombus formation in AF, but flow changes and their links to LA remodelling and contractility needed characterization.
Does left atrial 4D flow imaging identify differences in LA stasis and velocity between AF patients and healthy controls, and do these correlate with LA contractile function?
Does left atrial 4D flow imaging identify differences in LA stasis and velocity between AF patients and healthy controls, and do these correlate with LA contractile function?
4D flow MRI demonstrates increased left atrial stasis in AF patients compared to healthy controls, though this stasis does not correlate with traditional markers of LA contractile function.
4D flow detects higher LA stasis in AF without contractile correlation; leaves open its role in risk stratification.
Left atrial (LA) four-dimensional (4D) flow quantification and strain may help predict stroke and thrombus formation in patients with atrial fibrillation (AF). We aimed to characterize flow changes in AF patients undergoing pulmonary vein isolation (PVI) and their associations with LA remodelling and contractility markers. Fifty-seven consecutive patients referred for magnetic resonance imaging before first-time PVI and twelve healthy volunteers (HV). LA velocity and stasis maps were obtained from 4D flow. Cine images were used for LA volume, ejection fraction, and strain. Patients’ age was 60 ± 9 years (25% female), versus 44 ± 15 years in HV (8% female). LA 4D flow markers showed LA stasis was reduced in AF patients (median [Q1, Q3] 45.0% (36.0, 54.0) vs. 34.5% (22.8, 45.3); p = 0.040). LA stasis and mean LA velocity were associated in AF patients (r = −0.52; p < 0.001) and HV (r = −0.9; p < 0.001). Associations were poorer for peak LA velocity in AF patients (r = −0.39; p = 0.003). LA stasis was not associated with any marker of LA contractile function in either the AF or HV cohorts. In conclusion, compared with HV patients, patients with AF showed greater LA stasis on 4D flow. LA stasis was not associated with markers of LA contractile function.
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Sheitt et al. (2025) studied this question. In patients with atrial fibrillation, LA stasis was greater on 4D flow compared to healthy volunteers, median 45.0% vs 34.5%, p = 0.040.
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