Modeling left atrial volume, shape, and contraction patterns in normal subjects by cardiac magnetic resonance imaging

Bank, Andrew; Wickstrom, Kelly; Handran, Chauncy B.; Burkhoff, Daniel; Lesser, John R.; Schwartz, Robert S.

doi:10.1016/j.ijcard.2013.04.151

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…The absolute LA volumes using the three methods were analysed by two blinded experienced level 3 accredited observers (HP/ VV). LA volumes calculated from echocardiography using the BAL method were significantly lower than the CMR GS in the overall cohort (48.8±18.9mL/m 2 vs 68.6± 29.3mL/m 2 , p <0.0001) likely due to lower spatial resolution for detecting myocardialchamber borders 7 and foreshortening 8 (Table 1A).…”

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confidence: 93%

Left atrial dilation in patients with heart failure and preserved ejection fraction: Insights from cardiovascular magnetic resonance

Vassiliou

Patel

Rosen

et al. 2016

International Journal of Cardiology

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The left atrium (LA) is an important load-independent barometer of left ventricular filling pressure and diastolic dysfunction. In heart failure with preserved ejection fraction (HFpEF) measuring left atrial volume has come into vogue not least because LA dilatation forms part of the diagnostic criteria 1 but also as increased size is associated with worse outcomes 2 . Moreover, atrial reverse remodelling has been used as a surrogate marker of therapeutic success in clinical trials.Volumetric short axis Simpson's methods using cardiovascular magnetic resonance (CMR) 3,4 is widely considered gold-standard technique for calculating left atrial volume. Echocardiography is an alternative modality and, though more widely available and versatile than CMR, it has poorer spatial resolution and generally underestimates the true volume compared to CMR 3,5 . Multiple validation studies comparing the two modalities have focused on healthy volunteers alone. We sought to investigate whether LA volume calculated by 2D transthoracic echocardiography (biplane area-length [BAL] method) and CMR (BAL and gold standard volumetric Simpson's methods [CMR GS]) were comparable in a cohort of patients with HFpEF.We analysed 72 paired studies -echocardiograms (using a Philips iE33 machine with a S5-1 transducer) and CMR (1.5T Siemens Avanto Healthcare, Erlangen, Germany and analysed on CMRtools, Cardiovascular Imaging Solutions, London, UK) from 25 patients (age 74±6 years, 15 male) with HFpEF who participated in the Renal Denervation in HFpEF (RDT-PEF) study at our institution (Clinicaltrials.gov identifier: NCT01840059), three patients only had two CMR studies. The study protocol conformed to 1975 Helsinki guidelines, had been given regional ethical approval and all patients provided written informed consent.CMR and echocardiography studies were undertaken on the same day on three different occasions more than 90 days apart. For the CMR GS method, steady-state free precession (SSFP) cine imaging with contiguous stack of short-axis images across the LA was taken to calculate LA volume using the Simpson's method as previously described by our group 6 . For the BAL method, both for echo and CMR standard 2 chamber and 4 chamber views were also obtained to calculate LA volume as previously described 6 .In total 43 studies were performed in atrial fibrillation (AF), and 29 in sinus rhythm (SR). The absolute LA volumes using the three methods were analysed by two blinded experienced level 3 accredited observers (HP/ VV). LA volumes calculated from echocardiography using the BAL method were significantly lower than the CMR GS in the overall cohort (48.8±18.9mL/m 2 vs 68.6± 29.3mL/m 2 , p <0.0001) likely due to lower spatial resolution for detecting myocardialchamber borders 7 and foreshortening 8 (Table 1A).This difference was driven mainly by the presence of AF. Echo BAL vs CMR GS mean LA volume in SR was similar (39.5mL/m 2 vs 41.6mL/m 2 , p=0.60) but different in AF (54.6mL/m 2 vs 72.6mL/m 2 , p<0.0001). However, comparison of the volumes de...

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mentioning

confidence: 93%

Left atrial dilation in patients with heart failure and preserved ejection fraction: Insights from cardiovascular magnetic resonance

Vassiliou

Patel

Rosen

et al. 2016

International Journal of Cardiology

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“…In order to measure LA structure and function, simple assessments of length or area can be acquired, and model-based assumptions may be applied where the volume is calculated by ''bi-plane'' area-length measures (9) or by ellipsoid geometry (10). These assessments are quick, but shape modeling assumptions can be susceptible to errors since the LA is an asymmetric cavity.…”

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confidence: 99%

MRI of the left atrium at 3T: evaluation of measurement reproducibility in healthy volunteers and patients with cardiovascular disease

et al. 2016

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Background Left ventricular (LV) function has traditionally been the focus for cardiac magnetic resonance imaging (MRI) investigations, but similar methods can also be applied to the left atrium (LA). Previous studies elsewhere have almost entirely involved the use of 1.5T systems, but 3T MRI can provide faster data acquisition with thinner image slices, and may be more suitable for quantifying the structure and function of the LA. Purpose To evaluate 3T-MRI for LA volume assessments in: (i) healthy volunteers (HV); (ii) patients with LV-hypertrophy and ischemia (LVHI); and (iii) patients with LV-hypertrophy and diabetes (LVHD). Material and Methods Participants were imaged using a balanced steady-state free precession sequence. Healthy volunteers were scanned twice and patients were scanned on one occasion. Volumes were segmented by two observers, and coefficients of repeatability (CoR) were derived. Results For LA volumes (indexed to body surface area), CoRs were in the range of 1.3-4.6 mL/m. The LVHI patients had enlarged LA volumes (diastolic, 46.4 mL/m; systolic, 25.9 mL/m) and reduced ejection fraction (EF) (44.9%) relative to the HV (diastolic, 39.0 mL/m; systolic, 17.8 mL/m; EF, 54.5%) and LVHD groups (diastolic, 41.4 mL/m; systolic, 20.2 mL/m; EF, 50.7%). LA volumes were moderately correlated with LV mass in the HV group (R= 0.59 for LA end-systolic volume), but became weaker (R≤ 0.17) for patient groups. Conclusion 3T-MRI derived LA volume measurements are simple and repeatable, and can elicit clear differences between LVHI patients and HVs. These MRI endpoints provide scope for improved radiological interpretation of LA structure and function, and the high degree of repeatability validates their use for longitudinal investigations where precision work is essential.

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Transition from sinus rhythm to atrial fibrillation – A mechanism inducing or delaying pulmonary congestion and edema

Dori¹

2015

Medical Hypotheses

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Modeling left atrial volume, shape, and contraction patterns in normal subjects by cardiac magnetic resonance imaging

Cited by 4 publications

References 6 publications

Left atrial dilation in patients with heart failure and preserved ejection fraction: Insights from cardiovascular magnetic resonance

Left atrial dilation in patients with heart failure and preserved ejection fraction: Insights from cardiovascular magnetic resonance

MRI of the left atrium at 3T: evaluation of measurement reproducibility in healthy volunteers and patients with cardiovascular disease

Transition from sinus rhythm to atrial fibrillation – A mechanism inducing or delaying pulmonary congestion and edema

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