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Left atrial phasic transport function closely correlates with fibrotic and arrhythmogenic atrial tissue degeneration in atrial fibrillation patients: cardiac magnetic resonance feature tracking and voltage mapping

Abstract Aims To characterize the association of phasic left atrial (LA) transport function and LA fibrosis guided by multimodality imaging containing cardiac magnetic resonance imaging (CMR) feature tracking and bipolar voltage mapping. Methods and results Consecutive patients presenting for first-...

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Published in:Europace (London, England) England), 2021-09, Vol.23 (9), p.1400-1408
Main Authors: Schönbauer, Robert, Tomala, Jakub, Kirstein, Bettina, Huo, Yan, Gaspar, Thomas, Richter, Utz, Piorkowski, Judith, Schönbauer, Marie-Sophie, Fiedler, Lukas, Roithinger, Franz Xaver, Hengstenberg, Christian, Mascherbauer, Julia, Ulbrich, Stefan, Piorkowski, Christopher
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container_title Europace (London, England)
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creator Schönbauer, Robert
Tomala, Jakub
Kirstein, Bettina
Huo, Yan
Gaspar, Thomas
Richter, Utz
Piorkowski, Judith
Schönbauer, Marie-Sophie
Fiedler, Lukas
Roithinger, Franz Xaver
Hengstenberg, Christian
Mascherbauer, Julia
Ulbrich, Stefan
Piorkowski, Christopher
description Abstract Aims To characterize the association of phasic left atrial (LA) transport function and LA fibrosis guided by multimodality imaging containing cardiac magnetic resonance imaging (CMR) feature tracking and bipolar voltage mapping. Methods and results Consecutive patients presenting for first-time ablation of atrial fibrillation (AF) were prospectively enrolled. Each patient underwent CMR prior to the ablation procedure. LA phasic indexed volumes (LA-Vi) and emptying fractions (LA-EF) were calculated and CMR feature tracking guided LA wall motion analysis was performed. LA bipolar voltage mapping was carried out in sinus rhythm to find areas of low voltage as a surrogate for fibrosis and arrhythmogenesis. One hundred and sixty-eight patients were enrolled. Low-voltage areas (LVAs) were present in 70 patients (42%). Contrary to LA volume, CMR based LA-EF [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80–0.96, P = 0.005] and LA booster pump strain rate (SR) (OR 0.98, 95% CI 0.97–0.99, P = 0.001) significantly predicted presence and extent of LVA in multivariate logistic regression analysis for patients scanned in SR. In receiver operating characteristic analysis, LA-EF
doi_str_mv 10.1093/europace/euab052
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Methods and results Consecutive patients presenting for first-time ablation of atrial fibrillation (AF) were prospectively enrolled. Each patient underwent CMR prior to the ablation procedure. LA phasic indexed volumes (LA-Vi) and emptying fractions (LA-EF) were calculated and CMR feature tracking guided LA wall motion analysis was performed. LA bipolar voltage mapping was carried out in sinus rhythm to find areas of low voltage as a surrogate for fibrosis and arrhythmogenesis. One hundred and sixty-eight patients were enrolled. Low-voltage areas (LVAs) were present in 70 patients (42%). Contrary to LA volume, CMR based LA-EF [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80–0.96, P = 0.005] and LA booster pump strain rate (SR) (OR 0.98, 95% CI 0.97–0.99, P = 0.001) significantly predicted presence and extent of LVA in multivariate logistic regression analysis for patients scanned in SR. In receiver operating characteristic analysis, LA-EF &lt;40% carried a sensitivity of 83% and specificity of 76% (area under the curve 0.8; 95% CI 0.71–0.89) to predict presence of LVA. For patients scanned in AF only minimal LA-Vi on CMR (OR: 1.06; 95% CI: 1.02–1.10; P = 0.002) predicted presence of LVA. Conclusion For patients scanned in SR LA-EF and LA booster pump SR are closely linked to the presence and extent of LA LVA. Graphical Abstract Direct comparison of left atrial bipolar voltage map, longitudinal strain, and strain rate of a patient with (left panel) and without (right panel) left atrial low-voltage areas. Of note is the severely depressed left atrial booster pump function in the patient with low-voltage areas. Bipolar voltage map: low-voltage areas are defined as &lt;0.5 mV. Longitudinal strain analysis: time-dependent relationship between left atrial longitudinal dilation in % of baseline dilation. Longitudinal strain rate analysis: time-dependent relationship of velocity of longitudinal dilation in %/s of baseline dilation. The three left atrial functional phases are marked. AP, anterior posterior; LAA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PA, posterior anterior; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euab052</identifier><identifier>PMID: 33693595</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>Europace (London, England), 2021-09, Vol.23 (9), p.1400-1408</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. 2021</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c335t-ceac89590bf5039833dd62b9b75d593b3d80b2234650490f85ab6fe4e1601ea73</citedby><cites>FETCH-LOGICAL-c335t-ceac89590bf5039833dd62b9b75d593b3d80b2234650490f85ab6fe4e1601ea73</cites><orcidid>0000-0002-8284-2994 ; 0000-0001-7478-1450</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1604,27924,27925</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/europace/euab052$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33693595$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schönbauer, Robert</creatorcontrib><creatorcontrib>Tomala, Jakub</creatorcontrib><creatorcontrib>Kirstein, Bettina</creatorcontrib><creatorcontrib>Huo, Yan</creatorcontrib><creatorcontrib>Gaspar, Thomas</creatorcontrib><creatorcontrib>Richter, Utz</creatorcontrib><creatorcontrib>Piorkowski, Judith</creatorcontrib><creatorcontrib>Schönbauer, Marie-Sophie</creatorcontrib><creatorcontrib>Fiedler, Lukas</creatorcontrib><creatorcontrib>Roithinger, Franz Xaver</creatorcontrib><creatorcontrib>Hengstenberg, Christian</creatorcontrib><creatorcontrib>Mascherbauer, Julia</creatorcontrib><creatorcontrib>Ulbrich, Stefan</creatorcontrib><creatorcontrib>Piorkowski, Christopher</creatorcontrib><title>Left atrial phasic transport function closely correlates with fibrotic and arrhythmogenic atrial tissue degeneration in atrial fibrillation patients: cardiac magnetic resonance feature tracking and voltage mapping</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Abstract Aims To characterize the association of phasic left atrial (LA) transport function and LA fibrosis guided by multimodality imaging containing cardiac magnetic resonance imaging (CMR) feature tracking and bipolar voltage mapping. Methods and results Consecutive patients presenting for first-time ablation of atrial fibrillation (AF) were prospectively enrolled. Each patient underwent CMR prior to the ablation procedure. LA phasic indexed volumes (LA-Vi) and emptying fractions (LA-EF) were calculated and CMR feature tracking guided LA wall motion analysis was performed. LA bipolar voltage mapping was carried out in sinus rhythm to find areas of low voltage as a surrogate for fibrosis and arrhythmogenesis. One hundred and sixty-eight patients were enrolled. Low-voltage areas (LVAs) were present in 70 patients (42%). Contrary to LA volume, CMR based LA-EF [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80–0.96, P = 0.005] and LA booster pump strain rate (SR) (OR 0.98, 95% CI 0.97–0.99, P = 0.001) significantly predicted presence and extent of LVA in multivariate logistic regression analysis for patients scanned in SR. In receiver operating characteristic analysis, LA-EF &lt;40% carried a sensitivity of 83% and specificity of 76% (area under the curve 0.8; 95% CI 0.71–0.89) to predict presence of LVA. For patients scanned in AF only minimal LA-Vi on CMR (OR: 1.06; 95% CI: 1.02–1.10; P = 0.002) predicted presence of LVA. Conclusion For patients scanned in SR LA-EF and LA booster pump SR are closely linked to the presence and extent of LA LVA. Graphical Abstract Direct comparison of left atrial bipolar voltage map, longitudinal strain, and strain rate of a patient with (left panel) and without (right panel) left atrial low-voltage areas. Of note is the severely depressed left atrial booster pump function in the patient with low-voltage areas. Bipolar voltage map: low-voltage areas are defined as &lt;0.5 mV. Longitudinal strain analysis: time-dependent relationship between left atrial longitudinal dilation in % of baseline dilation. Longitudinal strain rate analysis: time-dependent relationship of velocity of longitudinal dilation in %/s of baseline dilation. The three left atrial functional phases are marked. AP, anterior posterior; LAA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PA, posterior anterior; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.</description><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFkc2u0zAQhS0E4l4Ke1bISyQUmNh1WrNDV_xJldjAOpo449aQ2MF2QH1Q3gfnpmXLakbH53y2dRh7XsPrGrR8Q3MMExoqC3agxAN2WyspKgFaPCw7aF2pWugb9iSl7wCwE1o9ZjdSNloqrW7ZnwPZzDFHhwOfTpic4TmiT1OImdvZm-yC52YIiYYzNyFGGjBT4r9dPnHruhhyyaDvOcZ4OufTGI7kF2mFZpfSTLynolLEe5zz19MF4IZhlacyyOf0lhuMvUPDRzx6WviRUvDoDXFLmOdIyyvND-eP91f_CkPGIxX_NBXtKXtkcUj07DI37NuH91_vPlWHLx8_3707VEZKlStDaPZaaeisAqn3UvZ9Izrd7VSvtOxkv4dOCLltFGw12L3CrrG0pbqBmnAnN-zlyp1i-DlTyu3okqHyH09hTq1QAHInoNA3DFariSGlSLadohsxntsa2qXM9lpmeymzRF5c6HM3Uv8vcG2vGF6thjBP_8f9BRaotJg</recordid><startdate>20210908</startdate><enddate>20210908</enddate><creator>Schönbauer, Robert</creator><creator>Tomala, Jakub</creator><creator>Kirstein, Bettina</creator><creator>Huo, Yan</creator><creator>Gaspar, Thomas</creator><creator>Richter, Utz</creator><creator>Piorkowski, Judith</creator><creator>Schönbauer, Marie-Sophie</creator><creator>Fiedler, Lukas</creator><creator>Roithinger, Franz Xaver</creator><creator>Hengstenberg, Christian</creator><creator>Mascherbauer, Julia</creator><creator>Ulbrich, Stefan</creator><creator>Piorkowski, Christopher</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8284-2994</orcidid><orcidid>https://orcid.org/0000-0001-7478-1450</orcidid></search><sort><creationdate>20210908</creationdate><title>Left atrial phasic transport function closely correlates with fibrotic and arrhythmogenic atrial tissue degeneration in atrial fibrillation patients: cardiac magnetic resonance feature tracking and voltage mapping</title><author>Schönbauer, Robert ; Tomala, Jakub ; Kirstein, Bettina ; Huo, Yan ; Gaspar, Thomas ; Richter, Utz ; Piorkowski, Judith ; Schönbauer, Marie-Sophie ; Fiedler, Lukas ; Roithinger, Franz Xaver ; Hengstenberg, Christian ; Mascherbauer, Julia ; Ulbrich, Stefan ; Piorkowski, Christopher</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c335t-ceac89590bf5039833dd62b9b75d593b3d80b2234650490f85ab6fe4e1601ea73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schönbauer, Robert</creatorcontrib><creatorcontrib>Tomala, Jakub</creatorcontrib><creatorcontrib>Kirstein, Bettina</creatorcontrib><creatorcontrib>Huo, Yan</creatorcontrib><creatorcontrib>Gaspar, Thomas</creatorcontrib><creatorcontrib>Richter, Utz</creatorcontrib><creatorcontrib>Piorkowski, Judith</creatorcontrib><creatorcontrib>Schönbauer, Marie-Sophie</creatorcontrib><creatorcontrib>Fiedler, Lukas</creatorcontrib><creatorcontrib>Roithinger, Franz Xaver</creatorcontrib><creatorcontrib>Hengstenberg, Christian</creatorcontrib><creatorcontrib>Mascherbauer, Julia</creatorcontrib><creatorcontrib>Ulbrich, Stefan</creatorcontrib><creatorcontrib>Piorkowski, Christopher</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Schönbauer, Robert</au><au>Tomala, Jakub</au><au>Kirstein, Bettina</au><au>Huo, Yan</au><au>Gaspar, Thomas</au><au>Richter, Utz</au><au>Piorkowski, Judith</au><au>Schönbauer, Marie-Sophie</au><au>Fiedler, Lukas</au><au>Roithinger, Franz Xaver</au><au>Hengstenberg, Christian</au><au>Mascherbauer, Julia</au><au>Ulbrich, Stefan</au><au>Piorkowski, Christopher</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Left atrial phasic transport function closely correlates with fibrotic and arrhythmogenic atrial tissue degeneration in atrial fibrillation patients: cardiac magnetic resonance feature tracking and voltage mapping</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2021-09-08</date><risdate>2021</risdate><volume>23</volume><issue>9</issue><spage>1400</spage><epage>1408</epage><pages>1400-1408</pages><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Abstract Aims To characterize the association of phasic left atrial (LA) transport function and LA fibrosis guided by multimodality imaging containing cardiac magnetic resonance imaging (CMR) feature tracking and bipolar voltage mapping. Methods and results Consecutive patients presenting for first-time ablation of atrial fibrillation (AF) were prospectively enrolled. Each patient underwent CMR prior to the ablation procedure. LA phasic indexed volumes (LA-Vi) and emptying fractions (LA-EF) were calculated and CMR feature tracking guided LA wall motion analysis was performed. LA bipolar voltage mapping was carried out in sinus rhythm to find areas of low voltage as a surrogate for fibrosis and arrhythmogenesis. One hundred and sixty-eight patients were enrolled. Low-voltage areas (LVAs) were present in 70 patients (42%). Contrary to LA volume, CMR based LA-EF [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80–0.96, P = 0.005] and LA booster pump strain rate (SR) (OR 0.98, 95% CI 0.97–0.99, P = 0.001) significantly predicted presence and extent of LVA in multivariate logistic regression analysis for patients scanned in SR. In receiver operating characteristic analysis, LA-EF &lt;40% carried a sensitivity of 83% and specificity of 76% (area under the curve 0.8; 95% CI 0.71–0.89) to predict presence of LVA. For patients scanned in AF only minimal LA-Vi on CMR (OR: 1.06; 95% CI: 1.02–1.10; P = 0.002) predicted presence of LVA. Conclusion For patients scanned in SR LA-EF and LA booster pump SR are closely linked to the presence and extent of LA LVA. Graphical Abstract Direct comparison of left atrial bipolar voltage map, longitudinal strain, and strain rate of a patient with (left panel) and without (right panel) left atrial low-voltage areas. Of note is the severely depressed left atrial booster pump function in the patient with low-voltage areas. Bipolar voltage map: low-voltage areas are defined as &lt;0.5 mV. Longitudinal strain analysis: time-dependent relationship between left atrial longitudinal dilation in % of baseline dilation. Longitudinal strain rate analysis: time-dependent relationship of velocity of longitudinal dilation in %/s of baseline dilation. The three left atrial functional phases are marked. AP, anterior posterior; LAA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PA, posterior anterior; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>33693595</pmid><doi>10.1093/europace/euab052</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-8284-2994</orcidid><orcidid>https://orcid.org/0000-0001-7478-1450</orcidid></addata></record>
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title Left atrial phasic transport function closely correlates with fibrotic and arrhythmogenic atrial tissue degeneration in atrial fibrillation patients: cardiac magnetic resonance feature tracking and voltage mapping
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