Left atrial calcification on chest CT: atrial ablation replaces rheumatic heart disease as the most identified etiology

• Published in: Polish journal of radiology 2023, Vol.88, p.423-429
• Main Authors: Chamberlin, Jordan H., Smith, Carter D., Gowani, Zain, Elsayed, Mina Gad, Owji, Shahin C., Friedman, Brandon, Maisuria, Dhruw, Berrios, Carly, Baruah, Dhiraj, Schoepf, Uwe Joseph, Kabakus, Ismail M.
• Format: Article
• Language: English
• Subjects: Original Paper
• ISSN: 1899-0967; 1733-134X; 1899-0967
• DOI: 10.5114/pjr.2023.131214

PurposeLeft atrial calcification (LAC), a primarily radiologic diagnosis, has been associated with rheumatic heart disease (RHD) and rheumatic fever (RF). However, left atrial calcification continues to be observed despite a significant decrease in the prevalence of rheumatic heart disease. The purpose of this study was to investigate other possible etiologies of left atrial calcification.Material and methodsThis retrospective, observational single-center study included patients from 2017 to 2022 identified as having left atrial calcification as well as age- and sex-matched controls. The prevalence of rheumatic heart disease, atrial ablation, and mitral valve disease was compared, and odds ratios were calculated for each independent variable.ResultsSixty-two patients with left atrial calcifications were included and compared with 62 controls. 87.1% of patients in the left atrial calcifications cohort had a history of atrial fibrillation compared with 21% in the control cohort (p < 0.001). 16.1% of patients in the calcifications cohort presented a history of rheumatic fever compared with zero in the control cohort (p = 0.004). 66.1% of the left atrial calcifications cohort had a history of atrial ablation compared with 6.5% of the control group (p < 0.001). The odds ratio for left atrial calcification was 19.0 vs. 4.8 for rheumatic fever (comparative odds = 4.0 for atrial ablation vs. rheumatic fever). Multivariable log model found atrial ablation to explain 79.8% of left atrial calcifications identified.ConclusionsOur study found a 4-fold higher association between history of atrial ablation and left atrial calcification compared with rheumatic heart disease, suggesting a potential shift in etiology.