Impact of Left Atrial Sphericity Index on the Outcome of Catheter Ablation for Atrial Fibrillation

Shi, Jiaran; Xu, Shuangbin; Chen, Leiyang; Wu, Bifeng; Yang, Kun; Chen, Shi; Zhou, Dongchen; Zhang, Biqi; Xuan, Tianming; Hu, Xinyang

doi:10.1007/s12265-020-10093-6

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…Time to event analysis showed significant predictive ability, especially for those with severe impairment of LA-ε t (third tertile; LA-ε t < 30%). The predictive role of LA strain had been previously shown in both echocardiography and CMR studies, in other cardiovascular diseases [ 12 , 31 , 38 , 40 ]. To date, this is the first study to prove the predictive ability of LA-ε t in NIDCM.…”

Section: Discussionmentioning

confidence: 92%

“…All LA phasic functions were considerably defective when compared with the control group, while corresponding LA strains were significantly impaired in patients with NIDCM, analogously to other published research [ 12 ]. Withal, in the diseased group, LASI was found to be considerably increased, whereas over half of patients had LA irreversible replacement fibrosis measured by LA-LGE, both being recently recognized as markers of LA remodelling [ 39 , 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

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Left Atrial Geometry and Phasic Function Determined by Cardiac Magnetic Resonance Are Independent Predictors for Outcome in Non-Ischaemic Dilated Cardiomyopathy

et al. 2021

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Left atrial (LA) geometry and phasic functions are frequently impaired in non-ischaemic dilated cardiomyopathy (NIDCM). Cardiac magnetic resonance (CMR) can accurately measure LA function and geometry parameters. We sought to investigate their prognostic role in patients with NIDCM. We prospectively examined 212 patients with NIDCM (49 ± 14.2-year-old; 73.5% males) and 106 healthy controls. LA volumes, phasic functions, geometry, and fibrosis were determined using CMR. A composite outcome (cardiac death, ventricular tachyarrhythmias, heart failure hospitalization) was ascertained over a median of 26 months. LA phasic functions, sphericity index (LASI) and late gadolinium enhancement (LA-LGE) were considerably impaired in the diseased group (p < 0.001) and significantly correlated with impaired LV function parameters (p < 0.0001). After multivariate analysis, LA volumes, LASI, LA total strain (LA-εt) and LA-LGE were associated with increased risk of composite outcome (p < 0.001). Kaplan–Meier analysis showed significantly higher risk of composite endpoint for LA volumes (all p < 0.01), LASI > 0.725 (p < 0.003), and LA-εt < 30% (p < 0.0001). Stepwise Cox proportional-hazards models demonstrated a considerable incremental predictive value which resulted by adding LASI to LA-εt (Chi-square = 10.2, p < 0.001), and afterwards LA-LGE (Chi-Square = 15.8; p < 0.0001). NIDCM patients with defective LA volumes, LASI, LA-LGE and LA-εt had a higher risk for an outcome. LA-εt, LASI and LA-LGE provided independent incremental predictive value for outcome.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Left Atrial Geometry and Phasic Function Determined by Cardiac Magnetic Resonance Are Independent Predictors for Outcome in Non-Ischaemic Dilated Cardiomyopathy

et al. 2021

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“…To further analyze CT segmentation by our geometrically encoded ML, we compared the left atrial volume and sphericity index between ML and expert readings. These indices are well reported measures of abnormal left atrial size and shape that predict recurrence of AF after drug therapy or ablation ( 44 , 45 ). Figures 6D , E shows that they were well correlated ( r = 0.99 and 0.95, respectively; p < 0 .…”

Section: Resultsmentioning

confidence: 99%

Segmenting computed tomograms for cardiac ablation using machine learning leveraged by domain knowledge encoding

Feng,

Deb,

Ganesan

et al. 2023

Front. Cardiovasc. Med.

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BackgroundSegmentation of computed tomography (CT) is important for many clinical procedures including personalized cardiac ablation for the management of cardiac arrhythmias. While segmentation can be automated by machine learning (ML), it is limited by the need for large, labeled training data that may be difficult to obtain. We set out to combine ML of cardiac CT with domain knowledge, which reduces the need for large training datasets by encoding cardiac geometry, which we then tested in independent datasets and in a prospective study of atrial fibrillation (AF) ablation.MethodsWe mathematically represented atrial anatomy with simple geometric shapes and derived a model to parse cardiac structures in a small set of N = 6 digital hearts. The model, termed “virtual dissection,” was used to train ML to segment cardiac CT in N = 20 patients, then tested in independent datasets and in a prospective study.ResultsIn independent test cohorts (N = 160) from 2 Institutions with different CT scanners, atrial structures were accurately segmented with Dice scores of 96.7% in internal (IQR: 95.3%–97.7%) and 93.5% in external (IQR: 91.9%–94.7%) test data, with good agreement with experts (r = 0.99; p < 0.0001). In a prospective study of 42 patients at ablation, this approach reduced segmentation time by 85% (2.3 ± 0.8 vs. 15.0 ± 6.9 min, p < 0.0001), yet provided similar Dice scores to experts (93.9% (IQR: 93.0%–94.6%) vs. 94.4% (IQR: 92.8%–95.7%), p = NS).ConclusionsEncoding cardiac geometry using mathematical models greatly accelerated training of ML to segment CT, reducing the need for large training sets while retaining accuracy in independent test data. Combining ML with domain knowledge may have broad applications.

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“…Moreover, time-to-event analysis has shown that it significantly increases the risk of outcome for a threshold of >0.5. Lately, the LASI determined by both echocardiography and CMR has been shown to be a marker of LA remodeling, atrial fibrillation recurrence, and HF hospitalization [36][37][38]. These findings suggest a close relationship between the LASI as a marker of LA remodeling and dysfunction and defective LA strains, thereby indicating that although LA dilation and dysfunction are at some point co-dependent, these pathogenetic processes are also independent of one another.…”

Section: The Ability Of La Parameters To Predict Composite Endpoint I...mentioning

confidence: 96%

Left atrial geometric and functional remodeling parameters measured by cardiac magnetic resonance imaging and outcome prediction in patients with severe aortic stenosis

et al. 2023

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Background: Emerging studies are beginning to describe the role of afflicted left atrium (LA) function and strain in cardiovascular diseases including aortic stenosis (AS), especially for risk stratification and outcome prediction. Cardiac magnetic resonance imaging (CMR) is becoming increasingly useful in determining LA parameters; however, in patients with AS, this approach has not been applied yet.Aims: This study sought to evaluate the role of CMR in characterizing LA geometry and function in patients with severe AS. Methods:We prospectively evaluated 70 patients with symptomatic severe AS and 70 controls. LA volumes, function, and strain were determined using CMR. A composite outcome (cardiac death, ventricular tachyarrhythmias, and heart failure hospitalization) was evaluated over a median of 13 months. Time-to-event outcomes were analyzed accordingly.Results: Besides increased LA volumes (LAVs) and LA sphericity index (LASI) (P <0.001), LA phasic functions and strain were considerably defective in patients with AS (all P <0.001). LV mass (LVM), end-diastolic and end-systolic volumes were also significantly associated withal LA strain parameters (P <0.001). Regarding outcome prediction, decreased total (LA-εt), active (LA-εa), and passive strain (LA-εp), along with enhanced LASI were independently associated with outcome (P <0.001). Time-to-event analysis showed a significantly higher risk to reach the composite outcome for LA-εt <31.1% (hazard ratio [HR], 6.981; 95% confidence interval [CI], 2.74-17.77; P <0.001), LA-εp <14.5% (HR, 2.68; 95% CI, 1.00-7.18; P <0.01), and LA-εa <21.2% (HR, 2.02; 95% CI, 1.07-3.83, P <0.03). Conclusion:Patients with severe AS have a significantly remodeled LA, with impaired phasic function and strain. Amongst all CMR parameters, LAVmin, LASI, LAPF, and LA-εp appear to be independent predictors for outcomes.

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Impact of Left Atrial Sphericity Index on the Outcome of Catheter Ablation for Atrial Fibrillation

Cited by 6 publications

References 21 publications

Left Atrial Geometry and Phasic Function Determined by Cardiac Magnetic Resonance Are Independent Predictors for Outcome in Non-Ischaemic Dilated Cardiomyopathy

Left Atrial Geometry and Phasic Function Determined by Cardiac Magnetic Resonance Are Independent Predictors for Outcome in Non-Ischaemic Dilated Cardiomyopathy

Segmenting computed tomograms for cardiac ablation using machine learning leveraged by domain knowledge encoding

Left atrial geometric and functional remodeling parameters measured by cardiac magnetic resonance imaging and outcome prediction in patients with severe aortic stenosis

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