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Extracellular volume fraction by T1 mapping predicts improvement of left ventricular ejection fraction after catheter ablation in patients with non-ischemic dilated cardiomyopathy and atrial fibrillation

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Abstract

Absence of myocardial fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI) is associated with improvement of left ventricular systolic function after catheter ablation (CA) for atrial fibrillation (AF) with non-ischemic dilated cardiomyopathy (NIDCM). Extracellular volume fraction (ECV) by T1 mapping has emerges as a non-invasive mean to quantify severity of myocardial fibrosis. The aim of this study was to assess the incremental value of ECV over LGE-MRI for the improvement of LVEF(∆EF) after CA in NIDCM patients. A total of thirty-two patients with NIDCM and AF (mean age 67.4 ± 9.3 years; 29 (91%) male) were retrospectively studied. Using a 1.5 T MR scanner and 32 channel cardiac coils, LGE-MRI, pre- and post-T1 mapping images of LV wall at mid-ventricular level (modified look-locker inversion recovery sequence) were acquired. All patients successfully underwent CA for AF, and the improvement of LVEF after CA were evaluated by echocardiography. All patients restored sinus rhythm after CA at the time of echocardiography. The mean LVEF was 35.1 ± 9.7% before CA and 52.2 ± 10.2% after CA (p < 0.001), resulting an increase of 17.4 ± 12.6%. Significant correlation was found between ∆LVEF and % LGE (r = − 0.49, p = 0.004), ∆LVEF and extracellular volume fraction (ECV) (r = − 0.47, p = 0.010). Area under the receiver operating characteristics curve (AUC) of combination of %LGE and ECV for predicting improvement of LVEF > 10% was substantially higher than that of %LGE alone (AUC: 0.830 vs 0.602). In NIDCM patients with AF, ECV had incremental value over %LGE for predicting improvement of EF by CA, suggesting that the assessment of diffuse interstitial fibrosis may be important to forecast the response of CA.

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Abbreviations

AUC:

Area under the curve

AF:

Atrial fibrillation

CA:

Catheter ablation

ECV:

Extracellular volume fraction

EF:

Ejection fraction

LGE:

Late gadolinium enhancement

LV:

Left ventricular

MRI:

Magnetic resonance imaging

NIDCM:

Non-ischemic dilated cardiomyopathy

ROC:

Receiver operating characteristics

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Acknowledgements

We are grateful to Masanori Ito, RT and Yuki Yoshimura, RT for CMR image acquisition.

Funding

Research Grant, Japan Society for the Promotion of Science: Grant-in-Aid for Early-Career Scientists.

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Author notes

  1. Mai Azuma and Shingo Kato have equally contribute to this work.

Authors and Affiliations

  1. Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan

    Mai Azuma, Ryusuke Sekii, Sho Kodama, Kei Kinoshita, Keisuke Suzurikawa, Minako Kagimoto, Naoki Nakayama, Kohei Iguchi & Kazuki Fukui

  2. Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan

    Tae Iwasawa

  3. Department of Diagnostic Radiology, Yokohama City University, Yokohama, Japan

    Shingo Kato & Daisuke Utsunomiya

  4. Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

    Kazuo Kimura

  5. Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Japan

    Kouichi Tamura

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  1. Mai Azuma
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Correspondence to Shingo Kato.

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Azuma, M., Kato, S., Sekii, R. et al. Extracellular volume fraction by T1 mapping predicts improvement of left ventricular ejection fraction after catheter ablation in patients with non-ischemic dilated cardiomyopathy and atrial fibrillation. Int J Cardiovasc Imaging 37, 2535–2543 (2021). https://doi.org/10.1007/s10554-021-02219-x

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