Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

Sante, Gabriele Di; Romano, Silvio; Alothman, Obaida; Frommhold, Markus; Borisov, Georgi; Garhy, Mohammad El; Issa, Karam; Penco, María; Raffa, Santi; Geller, J. Christoph

doi:10.1111/jce.14391

Cited by 10 publications

(6 citation statements)

References 40 publications

(79 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding is in accordance with the relationship between AF incidence and the CACS reported in a previous study 5 . Several risk factors for predicting the presence of LA‐LVA, such as age, female sex, LA volume, E/e′, and AF type, have been reported 13–15 . We confirmed the LA volume index as an independent predictor for LA‐LVA.…”

Section: Discussionsupporting

confidence: 92%

“…Among four predictors, we focused on the sex‐dependent distribution of LA‐LVA (<0.5 mV) and CACS, since both parameters were generally believed to be different between male and female patients 14–16 . All patients were divided into three categories according to their CACS (CACS 0, CACS 1–399, and CACS ≥ 400), and the LA‐LVA (<0.5 mV) ratios were compared among these categories.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, a good AUC of 0.782 was detected in the male patients of this study. In general, female sex is reported as a high‐risk factor for developing LA‐LVA 14,15 and stroke 19 . Thus, the pathogenesis of LA‐LVA in women may differ from that of men.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The coronary artery calcium score correlates with left atrial low‐voltage area: Sex differences

Hojo

Fukamizu

Tokioka

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction:In patients with coronary artery disease, a high coronary artery calcium score (CACS) correlates with atrial fibrillation (AF); however, the association between left atrial (LA) remodeling progression and coronary arteriosclerosis is unclear. This study aimed to evaluate the relationship between LA remodeling progression and the CACS. Methods: This retrospective study enrolled 148 patients with AF (paroxysmal AF, n = 94) who underwent catheter ablation. Voltage mapping for the left atrium and coronary computed tomography for CACS calculations were performed. The ratio of the LA low-voltage area (LA-LVA), defined by values less than 0.5 mV divided by the total LA surface without pulmonary veins, was calculated. Patients with LA-LVA (<0.5 mV) >5% and ≤5% were classified as the LVA (n = 30) and non-LVA (n = 118) groups, respectively. Patient characteristics and CACS values were compared between the two groups.Results: LA volume, age, CHA 2 DS 2 VASc score, and percentage of female patients were significantly higher, and the estimated glomerular filtration rate was lower in the LVA group than in the non-LVA group. The CACS was significantly higher in the LVA group (248.4 vs. 13.2; p = .001). Multivariate analysis identified the LA volume index and CACS as independent predictors of LA-LVA (<0.5 mV) greater than 5%.The areas under the receiver operating characteristic curves for predicting LA-LVA (<0.5 mV) greater than 5% with CACS were 0.695 in the entire population, 0.782 in men, and 0.587 in women. Conclusion: Progression of LA remodeling and coronary artery calcification may occur in parallel. A high CACS may indicate advanced LA remodeling, especially in men.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The coronary artery calcium score correlates with left atrial low‐voltage area: Sex differences

Hojo

Fukamizu

Tokioka

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…Despite this, prior prognostic models have most commonly used readily available, echocardiographically derived measures 10 . Studies that utilize cCT‐derived LAVi for post‐ablation prognostication arrive at these measurements through manual or semi‐automated segmentation, 20–23 a time‐intensive process that potentially limits its traction for routine clinical use despite widespread availability of pre‐ablation cCT. Our study leveraged deep learning to overcome these barriers and compute LAVi from cCT with both speed and accuracy.…”

Section: Discussionmentioning

confidence: 99%

Using machine learning to enhance prediction of atrial fibrillation recurrence after catheter ablation

Brahier,

Zou,

Abdulkareem

et al. 2023

Journal of Arrhythmia

View full text Add to dashboard Cite

BackgroundTraditional risk scores for recurrent atrial fibrillation (AF) following catheter ablation utilize readily available clinical and echocardiographic variables and yet have limited discriminatory capacity. Use of data from cardiac imaging and deep learning may help improve accuracy and prediction of recurrent AF after ablation.MethodsWe evaluated patients with symptomatic, drug‐refractory AF undergoing catheter ablation. All patients underwent pre‐ablation cardiac computed tomography (cCT). LAVi was computed using a deep‐learning algorithm. In a two‐step analysis, random survival forest (RSF) was used to generate prognostic models with variables of highest importance, followed by Cox proportional hazard regression analysis of the selected variables. Events of interest included early and late recurrence.ResultsAmong 653 patients undergoing AF ablation, the most important factors associated with late recurrence by RSF analysis at 24 (+/−18) months follow‐up included LAVi and early recurrence. In total, 5 covariates were identified as independent predictors of late recurrence: LAVi (HR per mL/m2 1.01 [1.01–1.02]; p < .001), early recurrence (HR 2.42 [1.90–3.09]; p < .001), statin use (HR 1.38 [1.09–1.75]; p = .007), beta‐blocker use (HR 1.29 [1.01–1.65]; p = .043), and adjunctive cavotricuspid isthmus ablation [HR 0.74 (0.57–0.96); p = .02]. Survival analysis demonstrated that patients with both LAVi >66.7 mL/m2 and early recurrence had the highest risk of late recurrence risk compared with those with LAVi <66.7 mL/m2 and no early recurrence (HR 4.52 [3.36–6.08], p < .001).ConclusionsMachine learning‐derived, full volumetric LAVi from cCT is the most important pre‐procedural risk factor for late AF recurrence following catheter ablation. The combination of increased LAVi and early recurrence confers more than a four‐fold increased risk of late recurrence.

show abstract

“…For example, increased left atrial volume is associated with increased stroke risk and atrial fibrillation recurrence following ablation [8], and decreased left atrial wall thickness can signify areas of structural remodelling and potential targets for ablation [9]. Furthermore, combining left atrial volume index with a patient's age and sex predict areas of low voltage and potential ablation targets through the use or a risk score calculation [10].…”

Section: Atrialmentioning

confidence: 99%

Role of advanced imaging with cardiac computed tomography and MRI in atrial and ventricular ablation

Morris

Carlson

Bhagat³

2022

Current Opinion in Cardiology

View full text Add to dashboard Cite

Purpose of reviewIncreasing evidence supports the use of advanced imaging with cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) in the work-up of patients with arrythmias being considered for ablation.Recent findingsAdvances in imaging technology and postprocessing are facilitating the use of advanced imaging before, during and after ablation in patients with both atrial and ventricular arrhythmias.In atrial arrythmias, quantitative assessment of left atrial wall thickness on CCT and quantification of late gadolinium enhancement (LGE) on CMR identify patients more likely to develop recurrent atrial arrythmias following ablation. In addition, in patients with recurrent arrythmia post ablation, LGE CMR can potentially identify targets for repeat ablation.In ventricular arrythmias, qualitative assessment of LGE can aide in determining the optimal ablation approach and predicts likelihood of ventricular arrythmias inducibility. Quantitative assessment of LGE can identify conduction channels that can be targeted for ablation. On CCT, quantitative assessment of left ventricular wall thickness can demonstrate myocardial ridges associated with re-entrant circuits for ablation.SummaryThis review focuses on the utility of CCT and CMR in identifying key anatomical components and arrhythmogenic substrate contributing to both atrial and ventricular arrhythmias in patients being considered for ablation. Advanced imaging has the potential to improve procedural outcomes, decrease complications and shorten procedural time.

show abstract

Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

Cited by 10 publications

References 40 publications

The coronary artery calcium score correlates with left atrial low‐voltage area: Sex differences

The coronary artery calcium score correlates with left atrial low‐voltage area: Sex differences

Using machine learning to enhance prediction of atrial fibrillation recurrence after catheter ablation

Role of advanced imaging with cardiac computed tomography and MRI in atrial and ventricular ablation

Contact Info

Product

Resources

About