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Assessment of left and right atrial 3D hemodynamics in patients with atrial fibrillation: a 4D flow MRI study

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Abstract

Atrial fibrillation (AF) is associated with embolic stroke due to thrombus formation in the left atrium (LA). Based on the relationship of atrial stasis to thromboembolism and the marked disparity in pulmonary versus systemic thromboembolism in AF, we tested the hypothesis that flow velocity distributions in the left (LA) versus right atrium (RA) in patients with would demonstrate increased stasis. Whole heart 4D flow MRI was performed in 62 AF patients (n = 33 in sinus rhythm during imaging, n = 29 with persistent AF) and 8 controls for the assessment of in vivo atrial 3D blood flow. 3D segmentation of the LA and RA geometry and normalized velocity histograms assessed atrial velocity distribution and stasis (% of atrial velocities <0.2 m/s). Atrial hemodynamics were similar for RA and LA and significantly correlated (mean velocity: r = 0.64; stasis: r = 0.55, p < 0.001). RA and LA mean and median velocities were lower in AF patients by 15–33 % and stasis was elevated by 11–19 % compared to controls. There was high inter-individual variability in LA/RA mean velocity ratio (range 0.5–1.8) and LA/RA stasis ratio (range 0.7–1.7). Patients with a history of AF and in sinus rhythm showed most pronounced differences in atrial flow (reduced mean velocities, higher stasis in the LA). While there is no systematic difference in LA versus RA flow velocity profiles, high variability was noted. Further delineation of patient specific factors and/or regional atrial effects on the LA and RA flow velocity profiles, as well as other factors such as differences in procoagulant factors, may explain the more prevalent systemic versus pulmonary thromboembolism in patients with AF.

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Funding sources

American Heart Association (12GRNT12080032) and the National Institutes of Health (1R21HL113895).

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Authors and Affiliations

  1. Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Avenue Suite 1600, Chicago, IL, 60611, USA

    Michael Markl, Maria Carr, Daniel C. Lee, Kelly Jarvis & James Carr

  2. Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jason Ng, Daniel C. Lee & Jeffrey J. Goldberger

  3. Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jason Ng, Daniel C. Lee & Jeffrey J. Goldberger

  4. Center for Cardiovascular Innovation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jeffrey J. Goldberger

  5. Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA

    Michael Markl & Kelly Jarvis

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  1. Michael Markl
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  2. Maria Carr
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  3. Jason Ng
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Correspondence to Michael Markl.

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Markl, M., Carr, M., Ng, J. et al. Assessment of left and right atrial 3D hemodynamics in patients with atrial fibrillation: a 4D flow MRI study. Int J Cardiovasc Imaging 32, 807–815 (2016). https://doi.org/10.1007/s10554-015-0830-8

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  • DOI: https://doi.org/10.1007/s10554-015-0830-8

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