Left atrial fibrosis assessed with cardiac mri in patients with paroxysmal and those with persistent atrial fibrillation

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Abstract

Background: Electrophysiology studies have demonstrated that left atrial late gadolinium enhancement (LGE) is associated with the chronicity of atrial fibrillation (AF). To date, cardiac MRI has been used to assess the extent of atrial LGE but not the distribution pattern of LGE in the left atrium. Purpose: To determine whether the MRI pattern of left atrial fibrosis is associated with the chronicity of AF. Materials and Methods: This retrospective study included patients with AF who underwent LGE MRI between June 2017 and May 2018. The presence of left atrial LGE was assessed at nine left atrial segments; the extent was determined by the number of segments involved. According to the chronicity of AF, patients were separated into paroxysmal AF (PAF) and persistent AF (PeAF) groups. The location and extent of left atrial LGE were compared between PAF and PeAF by using the x2 test and logistic regression analysis. Results: Of the 195 patients (mean age, 55 years 6 10 [standard deviation], 161 men), 74 (38%) had PAF and 121 (62%) had PeAF. Of all patients, 114 (58.4%) had at least one left atrial LGE segment. The mean number of LGE segments was higher (1.4 6 1.1 vs 0.6 6 0.7, P = .002) in the PeAF group than in the PAF group. The incidence of LGE at the left inferior pulmonary vein (LIPV) antrum was higher in the PeAF group than in the PAF group (39.2% [29 of 74] vs 7.4% [nine of 121]; P , .001). In multivariable analysis, LGE at the LIPV antrum was independently associated with PeAF (odds ratio = 4.2; 95% confidence interval: 1.7, 10.5; P , .001). Conclusion: The presence of fibrosis assessed with late gadolinium enhancement MRI of the left inferior pulmonary vein antrum was associated with persistent atrial fibrillation.

Original languageEnglish
Pages (from-to)575-582
Number of pages8
JournalRadiology
Volume292
Issue number3
DOIs
Publication statusPublished - 2019 Jan 1

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Gadolinium
Atrial Fibrillation
Fibrosis
Pulmonary Veins
Electrophysiology
Heart Atria
Retrospective Studies
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{5b1427b2dc654b60a4e0cfae99ec9d55,
title = "Left atrial fibrosis assessed with cardiac mri in patients with paroxysmal and those with persistent atrial fibrillation",
abstract = "Background: Electrophysiology studies have demonstrated that left atrial late gadolinium enhancement (LGE) is associated with the chronicity of atrial fibrillation (AF). To date, cardiac MRI has been used to assess the extent of atrial LGE but not the distribution pattern of LGE in the left atrium. Purpose: To determine whether the MRI pattern of left atrial fibrosis is associated with the chronicity of AF. Materials and Methods: This retrospective study included patients with AF who underwent LGE MRI between June 2017 and May 2018. The presence of left atrial LGE was assessed at nine left atrial segments; the extent was determined by the number of segments involved. According to the chronicity of AF, patients were separated into paroxysmal AF (PAF) and persistent AF (PeAF) groups. The location and extent of left atrial LGE were compared between PAF and PeAF by using the x2 test and logistic regression analysis. Results: Of the 195 patients (mean age, 55 years 6 10 [standard deviation], 161 men), 74 (38{\%}) had PAF and 121 (62{\%}) had PeAF. Of all patients, 114 (58.4{\%}) had at least one left atrial LGE segment. The mean number of LGE segments was higher (1.4 6 1.1 vs 0.6 6 0.7, P = .002) in the PeAF group than in the PAF group. The incidence of LGE at the left inferior pulmonary vein (LIPV) antrum was higher in the PeAF group than in the PAF group (39.2{\%} [29 of 74] vs 7.4{\%} [nine of 121]; P , .001). In multivariable analysis, LGE at the LIPV antrum was independently associated with PeAF (odds ratio = 4.2; 95{\%} confidence interval: 1.7, 10.5; P , .001). Conclusion: The presence of fibrosis assessed with late gadolinium enhancement MRI of the left inferior pulmonary vein antrum was associated with persistent atrial fibrillation.",
author = "Lee, {Dong Kyu} and Jaemin Shim and Choi, {Jong Il} and Kim, {Young Hoon} and Oh, {Yu Whan} and Hwang, {Sung Ho}",
year = "2019",
month = "1",
day = "1",
doi = "10.1148/radiol.2019182629",
language = "English",
volume = "292",
pages = "575--582",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "3",

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TY - JOUR

T1 - Left atrial fibrosis assessed with cardiac mri in patients with paroxysmal and those with persistent atrial fibrillation

AU - Lee, Dong Kyu

AU - Shim, Jaemin

AU - Choi, Jong Il

AU - Kim, Young Hoon

AU - Oh, Yu Whan

AU - Hwang, Sung Ho

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Electrophysiology studies have demonstrated that left atrial late gadolinium enhancement (LGE) is associated with the chronicity of atrial fibrillation (AF). To date, cardiac MRI has been used to assess the extent of atrial LGE but not the distribution pattern of LGE in the left atrium. Purpose: To determine whether the MRI pattern of left atrial fibrosis is associated with the chronicity of AF. Materials and Methods: This retrospective study included patients with AF who underwent LGE MRI between June 2017 and May 2018. The presence of left atrial LGE was assessed at nine left atrial segments; the extent was determined by the number of segments involved. According to the chronicity of AF, patients were separated into paroxysmal AF (PAF) and persistent AF (PeAF) groups. The location and extent of left atrial LGE were compared between PAF and PeAF by using the x2 test and logistic regression analysis. Results: Of the 195 patients (mean age, 55 years 6 10 [standard deviation], 161 men), 74 (38%) had PAF and 121 (62%) had PeAF. Of all patients, 114 (58.4%) had at least one left atrial LGE segment. The mean number of LGE segments was higher (1.4 6 1.1 vs 0.6 6 0.7, P = .002) in the PeAF group than in the PAF group. The incidence of LGE at the left inferior pulmonary vein (LIPV) antrum was higher in the PeAF group than in the PAF group (39.2% [29 of 74] vs 7.4% [nine of 121]; P , .001). In multivariable analysis, LGE at the LIPV antrum was independently associated with PeAF (odds ratio = 4.2; 95% confidence interval: 1.7, 10.5; P , .001). Conclusion: The presence of fibrosis assessed with late gadolinium enhancement MRI of the left inferior pulmonary vein antrum was associated with persistent atrial fibrillation.

AB - Background: Electrophysiology studies have demonstrated that left atrial late gadolinium enhancement (LGE) is associated with the chronicity of atrial fibrillation (AF). To date, cardiac MRI has been used to assess the extent of atrial LGE but not the distribution pattern of LGE in the left atrium. Purpose: To determine whether the MRI pattern of left atrial fibrosis is associated with the chronicity of AF. Materials and Methods: This retrospective study included patients with AF who underwent LGE MRI between June 2017 and May 2018. The presence of left atrial LGE was assessed at nine left atrial segments; the extent was determined by the number of segments involved. According to the chronicity of AF, patients were separated into paroxysmal AF (PAF) and persistent AF (PeAF) groups. The location and extent of left atrial LGE were compared between PAF and PeAF by using the x2 test and logistic regression analysis. Results: Of the 195 patients (mean age, 55 years 6 10 [standard deviation], 161 men), 74 (38%) had PAF and 121 (62%) had PeAF. Of all patients, 114 (58.4%) had at least one left atrial LGE segment. The mean number of LGE segments was higher (1.4 6 1.1 vs 0.6 6 0.7, P = .002) in the PeAF group than in the PAF group. The incidence of LGE at the left inferior pulmonary vein (LIPV) antrum was higher in the PeAF group than in the PAF group (39.2% [29 of 74] vs 7.4% [nine of 121]; P , .001). In multivariable analysis, LGE at the LIPV antrum was independently associated with PeAF (odds ratio = 4.2; 95% confidence interval: 1.7, 10.5; P , .001). Conclusion: The presence of fibrosis assessed with late gadolinium enhancement MRI of the left inferior pulmonary vein antrum was associated with persistent atrial fibrillation.

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U2 - 10.1148/radiol.2019182629

DO - 10.1148/radiol.2019182629

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