Aims: We aimed to compare cardiac volumes measured with echocardiography (echo) and cardiac magnetic resonance imaging (MRI) in a mixed cohort of healthy controls (controls) and patients with atrial fibrillation (AF). Materials and methods: In total, 123 subjects were included in our study; 99 full datasets were analyzed. All the participants underwent clinical evaluation, EKG, echo, and cardiac MRI acquisition. Participants with full clinical data were grouped into 63 AF patients and 36 controls for calculation of left atrial volume (LA Vol) and 51 AF patients and 30 controls for calculation of left ventricular end-diastolic volume (LV EDV), end-systolic volume (ESV), and LV ejection fraction (LV EF). Results: No significant differences in LA Vol were observed (p > 0.05) when measured by either echo or MRI. However, echo provided significantly lower values for left ventricular volume (p < 0.0001). The echo LA Vol of all the subjects correlated well with that measured by MRI (Spearmen correlation coefficient r = 0.83, p < 0.0001). When comparing the two methods, significant positive correlations of EDV (all subjects: r = 0.55; Controls: r = 0.71; and AF patients: r = 0.51) and ESV (all subjects: r = 0.62; Controls: r = 0.47; and AF patients: r = 0.66) were found, with a negative bias for values determined using echo. For a subgroup of participants with ventricular volumes smaller than 49.50 mL, this bias was missing, thus in this case echocardiography could be used as an alternative for MRI. Conclusion: Good correlation and reduced bias were observed for LA Vol and EF determined by echo as compared to cardiac MRI in a mixed cohort of patients with AF and healthy volunteers. For the determination of volume values below 49.50 mL, an excellent correlation was observed between values obtained using echo and MRI, with comparatively reduced bias for the volumes determined by echo. Therefore, in certain cases, echocardiography could be used as a less expensive, less time-consuming, and contraindication free alternative to MRI for cardiac volume determination.
Funding Acknowledgements Competitiveness Operational Programme 2014-2020 POC-A1-A1.1.4-E-2015, financed under the European Regional Development Fund, project number P_37_245 Background Atrial fibrillation (AF) is the most common human arrhythmia, associated with substantial morbidity and mortality. Histopathological studies of persistent AF have reported extracellular matrix remodelling with fibrotic infiltration in the myocardium, causing atrial dilation and electrical remodelling. Purpose In this pilot cohort study, we aimed to identify markers of persistent AF by comparing clinical data (ECG, echocardiography, cardiac MRI) from AF patients and age- and sex-matched healthy controls. Methods The study imATFIBis an observational, single-centre, cohort study (NCT03584126). The study was approved by the hospital ethics committee.Patients with AF visiting the outpatient clinic and healthy adult volunteers were examined clinically, by electrocardiography, echocardiography and cardiac MRI. For this primary analysis, we compared data from 16 patients (53 [50–59]YOA) and 16 age- and sex-matched controls (53.5 [50–59]YOA). We also compared AF patients with (N = 11; 67 [53–69]YOA) and without (N = 16; 56 [50–67]YOA) fibrosis (MRI). The unpaired Mann-Whitney t-test was used to test for significant differences. P values <0.05 were considered significant. Values are presented as medians and interquartile ranges, unless otherwise stated. Results Patients with AF presented a significant decrease in global myocardial wall strain as compared to healthy controls (-15%vs-19.5%, p = 0.008, N = 16), whereas there was no difference in their global ventricular systolic function (ejection fraction). Left atrial (LA) echocardiographic volume (110.90 [79.13–143.3] vs59.59 [43.32–69.50] cm3) and LA volume normalized to body surface area (BSA) (54.66 [41.00–70.83] vs32.71 [22.74–35.46] cm3/m2) were significantly higher in patients (all p < 0.001). Similarly, on cardiac MRI, a significantly increased LA volume of patients with AF (98.97 [78.12–116.7] vs65.92 [49.99–80.48]cm3) and LA volume/BSA (46.28 [39.68–60.98] vs32.32 [25.62–38.55]cm3/m2) were observed (all p < 0.001). Moreover, the LA transversal (53 [46–58] vs45 [40–50] mm) and LA longitudinal diameters (63 [50-68] vs48 (41–53.5] mm), and LA area (26.5 [22.3–32.0] vs19.5 [15.3–22.0] cm2) were significantly higher in patients with AF (all p < 0.01). When comparing LA volume and LA volume/BSA, we did not find significant differences between echocardiography and cardiac MRI. When analysing AF patients with and without fibrosis via cardiac MRI, LA volume had an increased trend in fibrotic patients (111.30 [100.30–140.20] vs98.58 [77.41–118.10] cm3, p = 0.054); whereas, LA volume/BSA (61.38 [58.88–80.35] vs45.09 [38.51–59.25] cm3/m2, p < 0.01) and LA area (30.80 [27.60–35.80]vs23.45 [20.93–31.28] cm2, p = 0.008) were significantly higher in fibrotic patients. Conclusions.There was an increased left atrial volume and diameters in patients with AF as compared to healthy controls. Patients with AF had a decreased global myocardial strain suggesting incipient left ventricular systolic dysfunction.
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