Non-Contrast cardiac magnetic resonance for left atrial appendage occlusion Planning: A comparative study with cardiac CTA

Q: What are the key findings of this study?

Non-contrast cardiac magnetic resonance provided left atrial appendage landing zone area measurements (521.2 vs 523.9 mm2; P=0.759) comparable to CCTA for occlusion device planning.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrial fibrillation scheduled for left atrial appendage occlusion (n=30). Intervention: Non-contrast cardiac magnetic resonance (CMR) vs. Cardiac CT angiography (CCTA). Primary outcome: Landing zone area (mm2) (p=0.759).

Q: What does this research mean for the field?

Non-contrast cardiac magnetic resonance provides left atrial appendage landing zone measurements and optimal projection angle predictions comparable to cardiac CT angiography for occlusion planning. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Qingsong Wang; Bao Jie; Menglu Li; Xinyan Wang; Tingting SONG; Kaizhou Yang; Yuanyuan Xing; Liuquan Cheng; Jun Guo; Tao Chen

doi:10.1016/j.ejrad.2026.113170

August 20, 2026European Journal of Radiology

Non-Contrast cardiac magnetic resonance for left atrial appendage occlusion Planning: A comparative study with cardiac CTA

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Key result

Non-contrast CMR matches CCTA for left atrial appendage landing zone measurements in occlusion planning.

P=0.759
n=30

Why the study?

Accurate preprocedural imaging for LAAO device sizing is essential, but CCTA use is limited by radiation and contrast exposure.

Does non-contrast CMR provide comparable landing zone measurements and device sizing to CCTA for LAAO planning in patients with atrial fibrillation?

Key Points

To evaluate non-contrast cardiac magnetic resonance for left atrial appendage occlusion preprocedural sizing and projection angle planning compared to cardiac CT angiography and digital subtraction angiography.
Enrolled 32 patients with atrial fibrillation scheduled for left atrial appendage occlusion between April 2024 and October 2025, with 30 completing both non-contrast CMR and CCTA (mean age 66.9 years).
Measured landing zone dimensions using identical 3D multiplanar protocols across non-contrast CMR and CCTA, calculating area-derived equivalent diameters.
Compared predicted optimal fluoroscopic projection angles and landing zone dimensions against intraprocedural digital subtraction angiography and final implanted device size via Bland-Altman analysis.
Landing zone measurements showed no significant difference between CMR and CCTA for landing zone area (521.2 ± 210.0 vs 523.9 ± 225.9 mm², p = 0.759) or area-derived diameter (25.3 ± 5.1 vs 25.5 ± 5.4 mm, p = 0.475).
Maximum diameter on DSA was significantly smaller than direct CMR and CCTA diameters (p < 0.05), but did not differ significantly from area-derived diameters (p = 0.355).
CMR area-derived diameter closely agreed with final implanted device size (mean bias -2.76 mm; 95% limits of agreement -6.97 to 1.45 mm), matching the predictive performance of CCTA.

Study Design

Type

Cross-Sectional (n=30)

Structured PICO

Does non-contrast CMR provide comparable landing zone measurements and device sizing to CCTA for LAAO planning in patients with atrial fibrillation?

P

Population

30 patients with atrial fibrillation (mean age 66.9 years) scheduled for left atrial appendage occlusion who underwent both non-contrast CMR and CCTA.

E

Exposure

Non-contrast cardiac magnetic resonance (CMR) imaging for left atrial appendage occlusion (LAAO) planning

C

Comparator

Cardiac CT angiography (CCTA) and digital subtraction angiography (DSA)

O

Outcome

Landing zone measurements (area and area-derived equivalent diameter), prediction of optimal fluoroscopic projection angles (OPA), and agreement with implanted device sizesurrogate

Main Result

Absolute Event Rate: 521.2% vs 523.9%

p-value: p=0.759

Implication

Non-contrast CMR provides landing zone measurements and fluoroscopic angle predictions comparable to CCTA, presenting a viable contrast-free and radiation-free alternative for LAAO planning.

Abstract

BACKGROUND Accurate preprocedural imaging is essential for left atrial appendage occlusion (LAAO) device sizing. Although cardiac CT angiography (CCTA) is widely used, radiation and contrast limit its use. PURPOSE To assess non-contrast cardiac MR (CMR) for LAAO planning by comparing measurements with CCTA and digital subtraction angiography (DSA), evaluating agreement with implanted device size, and predicting optimal fluoroscopic projection angles (OPA). MATERIALS AND METHODS Thirty-two patients with atrial fibrillation scheduled for LAAO (April 2024-October 2025) underwent non-contrast CMR and CCTA before DSA. Landing zone dimensions and morphology were assessed using identical 3D multiplanar protocols. Area-derived equivalent diameter was used for sizing. OPA predicted by CMR and CCTA were compared with DSA. Agreement with final device size was analyzed using Bland-Altman plots. RESULTS Thirty patients (mean age 66.9 years) completed both exams; LAAO succeeded in 29 (96.7 %). CMR and CCTA showed no significant differences in landing zone measurements (area: 521.2 ± 210.0 vs 523.9 ± 225.9 mm2,p = 0.759; area-derived diameter: 25.3 ± 5.1 vs 25.5 ± 5.4 mm,p = 0.475). DSA maximum diameter was smaller than direct CMR/CCTA diameters (p < 0.05) but similar to area-derived diameters (p = 0.355). CMR area-derived diameter closely agreed with device size (bias - 2.76 mm; limits - 6.97 to 1.45 mm), comparable to CCTA. Predicted OPA from CMR agreed with DSA and CCTA. CONCLUSION Non-contrast CMR provides measurements and OPA prediction comparable to CCTA, supporting its feasibility as a radiation- and contrast-free alternative for selected patients.

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Cite This Study

Wang et al. (2026) conducted a cross-sectional in Atrial fibrillation scheduled for left atrial appendage occlusion (n=30). Non-contrast cardiac magnetic resonance (CMR) vs. Cardiac CT angiography (CCTA) was evaluated on Landing zone area (mm2) (p=0.759). Non-contrast cardiac magnetic resonance provided left atrial appendage landing zone area measurements (521.2 vs 523.9 mm2; P=0.759) comparable to CCTA for occlusion device planning.

synapsesocial.com/papers/6ad115a100741cc3fba7d6d2 https://doi.org/10.1016/j.ejrad.2026.113170