Key result
Paroxysmal atrial fibrillation was associated with significantly greater left ventricular extracellular volume fraction (28.7% vs 26.6%, p=0.002) and decreased active left atrial strain compared to healthy controls.
Why the study?
Early detection of LA and LV remodeling in paroxysmal AF could identify risk of progression, motivating evaluation of CMR-derived feature tracking LA strain and LV extracellular volume fraction.
Does cardiovascular magnetic resonance feature tracking left atrial strain and left ventricular extracellular volume fraction detect early remodeling in patients with paroxysmal atrial fibrillation compared to healthy controls?
Observational (n=126)
No
Does cardiovascular magnetic resonance feature tracking left atrial strain and left ventricular extracellular volume fraction detect early remodeling in patients with paroxysmal atrial fibrillation compared to healthy controls?
Absolute Event Rate: 28.7% vs 26.6%
p-value: p=0.002
CMR-FT LA strain combined with LV-ECV can detect subtle LA booster pump dysfunction and advanced LV myocardial fibrosis in patients with paroxysmal atrial fibrillation, providing early markers of LA/LV remodeling.
May aid early risk stratification in paroxysmal AF; leaves open whether it alters management or outcomes.
Atrial fibrillation (AF) is a progressive disease that starts with structural or functional changes in the left atrium and left ventricle, and evolves from paroxysmal toward sustained forms. Early detection of structural or functional changes in the left atrium and left ventricle in the paroxysmal stage could be useful for identifying higher risk of progression to persistent AF and future cardio-cerebrovascular events. The aim of this study was to test the hypothesis that feature tracking (FT) left atrial (LA) strain and left ventricular (LV) extracellular volume fraction (ECV) derived from cardiovascular magnetic resonance (CMR) could detect the early changes of remodeling in the left atrium and ventricle in the stage of paroxysmal AF (PAF).Participants comprised 106 PAF patients (age, 66.1 ± 10.7 years; 66% male) who underwent clinical CMR before pulmonary vein isolation and 20 control subjects (age, 68.3 ± 8.6 years; 55% male). CMR-FT LA strain/phasic function and LV-ECV were compared between the PAF and control groups. Total and passive LA empty fraction (LAEF) and LA strain (corresponding to LA reservoir and conduit function) were decreased in the PAF group compared to the control group. However, active LAEF (corresponding to LA booster pump function) did not differ significantly between the PAF group (33.9 ± 10.9%) and control group (37.9 ± 13.3%, p = 0.15), while active LA strain (corresponding to LA booster pump function) was significantly decreased in the PAF group (11.4 ± 4.3 vs. 15.2 ± 5.6%, p = 0.002). LV-ECV was significantly greater in the PAF group (28.7 ± 2.8%) than in the control group (26.6 ± 2.0%, p = 0.002). In the PAF group, LV-ECV correlated significantly with E/e’ and LA volume index. Regarding LA strain, correlations were seen between LV-ECV and both reservoir function and conduit function.CMR-FT LA strain in combination with LV-ECV offers a potential imaging marker that identifies LA/LV remodeling including subtle LA booster pump dysfunction undetectable by conventional booster pump LAEF in the stage of PAF. These findings provide new insights into LA-LV interactions and further investigation regarding association between perpetuation of AF and LA functional remodeling in PAF patients.
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Yamada et al. (2021) conducted an observational in Paroxysmal Atrial Fibrillation (n=126). Paroxysmal Atrial Fibrillation vs. Healthy control subjects was evaluated on Left ventricular extracellular volume fraction (LV-ECV) (p=0.002). Paroxysmal atrial fibrillation was associated with significantly greater left ventricular extracellular volume fraction (28.7% vs 26.6%, p=0.002) and decreased active left atrial strain compared to healthy controls.
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