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Atrial fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation

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Abstract

A relationship between left atrial strain and pressure has been demonstrated in many studies, but not in an atrial fibrillation (AF) cohort. In this work, we hypothesized that elevated left atrial (LA) tissue fibrosis might mediate and confound the LA strain vs. pressure relationship, resulting instead in a relationship between LA fibrosis and stiffness index (mean LA pressure/LA reservoir strain). Sixty-seven patients with AF underwent a standard cardiac MR exam including long-axis cine views (2 and 4-ch) and a free-breathing high resolution three-dimensional late gadolinium enhancement (LGE) of the atrium (N = 41), within 30 days prior to AF ablation, at which procedure invasive mean left atrial pressure (LAP) was measured. LV and LA Volumes, EF, and comprehensive analysis of LA strains (strain and strain rates and strain timings during the atrial reservoir, conduit and active, i.e. active atrial contraction, phases) were measured and LA fibrosis content (LGE (ml)) was assessed from 3D LGE volumes. LA LGE was well correlated to atrial stiffness index overall (R = 0.59, p < 0.001), and among patient subgroups. Pressure was only correlated to maximal LA volume (R = 0.32) and the time to peak reservoir strain rate (R = 0.32) (both p < 0.01), among all functional measurements. LA reservoir strain was strongly correlated with LAEF (R = 0.95, p < 0.001) and LA minimum volume (r = 0.82, p < 0.001). In our AF cohort, pressure is correlated to maximum LA volume and time to peak reservoir strain. LA pressure/ LA reservoir strain, a metric of stiffness, correlates with LA fibrosis (LA LGE), reflecting Hook’s Law.

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Data availability

The strain analysis package is available upon reasonable request from the authors. The data consists of pressure, strains, functional metrics, and atrial fibrosis, and will be available from the last author upon reasonable request.

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Funding

The authors acknowledge funding from NIH: NIH 1R01HL144706, Development of MR-derived parameters of LV diastolic function: Validation and Comparison to LV and LA fibrosis.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA

    Jérôme Lamy, Hamid Mojibian, Steffen Huber & Dana C. Peters

  2. Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA

    Roy Taoutel, Romy Chamoun, Joseph Akar, Lauren A. Baldassarre & Judith Meadows

  3. Kings College London, London, UK

    Steven Niederer

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Contributions

JL: Conception, interpretation, creation of new software, analysis, acquisition of data, drafted and revised manuscript, approved manuscript, accountable for integrity. RT: Analysis, acquisition of data, revised manuscript, approved manuscript, accountable for integrity. RC: Analysis, acquisition of data, revised manuscript, approved manuscript, accountable for integrity. JA: Conception, interpretation, revised manuscript, approved manuscript, accountable for integrity. SN: Interpretation, revised manuscript, approved manuscript, accountable for integrity. HM: Acquisition of data, revised manuscript, approved manuscript, accountable for integrity. SH: Acquisition of data, revised manuscript, approved manuscript, accountable for integrity. LB: Conception, interpretation, revised manuscript, approved manuscript, accountable for integrity. JM: Conception, interpretation, approved manuscript, accountable for integrity. DCP: Conception, interpretation, creation of new software, analysis, acquisition of data, drafted and revised manuscript, approved manuscript, accountable for integrity.

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Correspondence to Dana C. Peters.

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The study was approved by Yale institutional review board, as exempt chart review study; informed consent was not required.

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Supplementary file1 P-value heat map corresponding the heat map of correlations presented in Figure 4. (TIF 822 KB)

Supplementary file2 Video S1: LA_strain.avi. This movie shows tracking for representative two- and four-chamber cines, as well as plots of longitudinal strain and strain rate for 2ch, 4ch and averaged. The peaks in strain and strain rate are also indicated by “x”. (AVI 2288 KB)

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Lamy, J., Taoutel, R., Chamoun, R. et al. Atrial fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation. Int J Cardiovasc Imaging 40, 107–117 (2024). https://doi.org/10.1007/s10554-023-02968-x

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