Cardiac magnetic resonance imaging for preprocedural planning of percutaneous left atrial appendage closure

Figure 1. By intersection of the projection lines (yellow lines) of the landing zone identified in XR (yellow dots) with the left atrial appendage segmented from pre-procedural registered CMR (red), the landing zone was localized in 3D (blue dots).

Figure 2. The diameter of the landing zone measured by CMR (A,B), TEE (C), and XR (D). Based on CMR, maximum (A, white solid line) and minimum (A, orange dashed line) diameters and diameters calculated from perimeter (B, white dashed line) and area (B, orange area) measurements of the landing zone were derived.

Figure 3. CMR-derived ostium (red) and landing zone (green) superimposed onto angiographical simulation in (A) the recommended angulation and (B) patient-specific optimal angulation.

Figure 4. MPR views of two LAA anatomies (first anatomy (A–C); second anatomy (D–F)) exemplifying the ability of non-contrast-enhanced CMR to identify the LAA anatomy and the landing zone marker Cx (white highlighted).

Figure 5. (A,B) Correlation and (C,D) Bland-Altman analysis of LAA diameters derived from XR (dXR) and CMR (d’) imaging at identical landing zone. (A,C) Shows the CMR-derived maximum diameter (d’max) and (B,D) the diameter of the landing zone parallel to the projection plane (d’proj). scatter plot: ideal correlation (green dashed line), least square fit through data points (orange line); Bland-Altman plot: zero line (green dashed line), mean difference (orange solid line), limits of agreement (orange dashed line), confidence interval of mean difference (orange area).

Figure 6. Correlation of LAA diameter at landing zone derived from CMR with (A–C) diameters derived from XR (dXR) and with (D–F) diameters derived from TEE (dTEE). (A,D) Shows the maximum diameter dmax, (B,E) diameter derived from perimeter (dperi), and (C,F) diameter derived from area (darea) (ideal correleation: green dashed line; least square fit through data points: orange line).

Figure 7. Bland-Altman analysis of landing zone diameters derived from CMR-based landing zone ((A, C) perimeter-derived (dperi) and (B, D) area-derived (darea)) in comparison to diameters derived from (A,B) x-ray fluoroscopy (dXR) and (C,D) transesophageal echocardiography (dTEE). (Zero line: green dashed line; mean difference: orange solid line; limits of agreement: orange dashed line; confidence interval of mean difference: orange area).