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Quantification of left atrial volume and phasic function using cardiovascular magnetic resonance imaging—comparison of biplane area-length method and Simpson's method

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Abstract

Left atrial (LA) enlargement and dysfunction are markers of chronic diastolic dysfunction and an important predictor of adverse cardiovascular and cerebrovascular outcomes. Accordingly, accurate quantification of left atrial volume (LAV) and function is needed. In routine clinical cardiovascular magnetic resonance (CMR) imaging the biplane area-length method (Bi-ALM) is frequently applied due to time-saving image acquisition and analysis. However, given the varying anatomy of the LA we hypothesized that the diagnostic accuracy of the Bi-ALM is not sufficient and that results would be different from a precise volumetric assessment of transversal multi-slice cine images using Simpson's method. Thirty one patients of the FIND-AFRANDOMISED-study with status post acute cerebral ischemia (mean age 70.5 ± 6.2 years) received CMR imaging at 3T. The study protocol included cine SSFP sequences in standard 2- and 4 CV and a stack of contiguous slices in transversal orientation. Total, passive and active LA emptying fractions were calculated from LA maximal volume, minimal volume and volume prior to atrial contraction. Intra- and inter-observer variability was assessed in ten patients. Significant differences were found for LA volume and phasic function. The Bi-ALM significantly underestimated LA volume and overestimated LA function in comparison to Simpson's method (Bi-ALM vs. Simpson's method: LAVmax: 80.18 vs. 98.80 ml; LAVpre−ac: 61.09 vs. 80.41 ml; LAVmin: 36.85 vs. 52.66 ml; LAEFTotal: 55.17 vs. 47.85%; LAEFPassive: 23.96 vs. 19.15%; LAEFBooster: 40.87 vs. 35.64%). LA volumetric and functional parameters were reproducible on an intra- and inter-observer levels for both methods. Intra-observer agreement for LA function was better for Simpson's method (Bi-ALM vs. Simpson's method; ICC LAEFTotal: 0.84 vs. 0.96; ICC LAEFPassive: 0.74 vs. 0.92; ICC LAEFBooster: 0.86 vs. 0.89). The Bi-ALM is based on geometric assumptions that do not reflect the complex individual LA geometry. The assessment of transversal slices covering the left atrium with Simpson's method is feasible and might be more suitable for an accurate quantification of LA volume and phasic function.

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Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany

    Laura Kristin Wandelt, Johannes Tammo Kowallick, Christina Unterberg-Buchwald, Christian Oliver Ritter, Joachim Lotz & Wieland Staab

  2. German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany

    Laura Kristin Wandelt, Johannes Tammo Kowallick, Andreas Schuster, Rolf Wachter, Thomas Stümpfig, Christina Unterberg-Buchwald, Michael Steinmetz, Christian Oliver Ritter, Joachim Lotz & Wieland Staab

  3. Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany

    Andreas Schuster, Rolf Wachter & Christina Unterberg-Buchwald

  4. Department of Paediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany

    Thomas Stümpfig & Michael Steinmetz

Authors
  1. Laura Kristin Wandelt
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  2. Johannes Tammo Kowallick
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  3. Andreas Schuster
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  4. Rolf Wachter
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  6. Christina Unterberg-Buchwald
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  7. Michael Steinmetz
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Correspondence to Laura Kristin Wandelt.

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The present study has been approved by the ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All study participants gave their informed consent prior to their inclusion in the study.

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Wandelt, L.K., Kowallick, J.T., Schuster, A. et al. Quantification of left atrial volume and phasic function using cardiovascular magnetic resonance imaging—comparison of biplane area-length method and Simpson's method. Int J Cardiovasc Imaging 33, 1761–1769 (2017). https://doi.org/10.1007/s10554-017-1160-9

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  • DOI: https://doi.org/10.1007/s10554-017-1160-9

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