Key result
TR-MRA-derived time-to-peak identifies elevated left atrial pressure with an AUC of ~0.83.
Why the study?
Non-invasive estimation of elevated left atrial pressure using echocardiography in patients with atrial fibrillation remains unclear.
Does non-invasive imaging using TR-MRA derived time-to-peak and echocardiographic parameters accurately identify elevated left atrial pressure in patients with atrial fibrillation?
Observational (n=92)
Single-blind
No
Does non-invasive imaging using TR-MRA derived time-to-peak and echocardiographic parameters accurately identify elevated left atrial pressure in patients with atrial fibrillation?
Effect estimate: AUC 0.834 (95% CI 0.742-0.904)
p-value: p=<0.001
TR-MRA-derived time-to-peak and echocardiographic parameters (such as the septal E/e' ratio) provide reliable, non-invasive markers to estimate elevated left atrial pressure in patients with atrial fibrillation undergoing catheter ablation.
TR-MRA time-to-peak may aid noninvasive LAP estimation in AF; leaves open prospective validation before clinical adoption.
AIMS: Determining elevated left atrial (LA) pressure is crucial in patients with atrial fibrillation (AF), yet non-invasive estimation using echocardiography remains unclear. This study aimed to identify useful echocardiographic indices for identifying elevated LA pressure in patients with AF. METHODS AND RESULTS: Patients with paroxysmal or persistent AF referred for catheter ablation at two tertiary hospitals were prospectively enrolled. Mean LA pressure was measured immediately after transseptal puncture. Elevated mean LA pressure was defined as ≥15 mmHg. Transthoracic echocardiography was performed to acquire the guideline-recommended parameters. A total of 176 patients were included, and 63 (36%) patients had a mean LA pressure ≥15 mmHg. Patients with elevated LA pressure had more frequent hypertension, larger LA, higher septal E/e', and worse LA strain than the remaining patients. The correlations between mean LA pressure and each echocardiographic parameter were weak. Septal E/e' ratio showed the best correlation with mean LA pressure (r = 0.351, P < 0.001), and septal E/e' ratio ≥11 was the best parameter (area under the curve = 0.7, sensitivity = 65%, specificity = 73%, accuracy = 70%) to identify elevated mean LA pressure. A hierarchical algorithm consisting of septal E/e' ratio, LA reservoir strain, and LA volume index improved identification of patients with elevated mean LA pressure (sensitivity = 61%, specificity = 91%, accuracy = 80%). CONCLUSION: In patients with AF, the septal E/e' ratio was the best single parameter for identifying elevated mean LA pressure. A hierarchical algorithm combining the septal E/e' ratio, LA reservoir strain, and LA volume index helps identify elevated LA pressure in patients with AF.
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Seo et al. (2024) conducted an observational in Atrial fibrillation (n=92). Time-resolved magnetic resonance angiography (TR-MRA) derived time-to-peak (TTP) vs. Invasive left atrial pressure measurement (Low LAP <15 mmHg) was evaluated on Identification of elevated left atrial pressure (≥15 mmHg) (AUC 0.834, 95% CI 0.742-0.904, p=<0.001). TR-MRA-derived time-to-peak accurately identified elevated left atrial pressure (≥15 mmHg) with an area under the curve of 0.834.
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