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González-Ferrero T, Bergonti M, Marcon L, Minguito-Carazo C, Tilves Bellas C, Pesquera Lorenzo JC, Martínez-Sande JL, González-Melchor L, García-Seara FJ, Fernández-López JA, González-Juanatey JR, Heidbuchel H, Sarkozy A, Rodríguez-Mañero M. Characterization of patients with extensive left atrial myopathy referred for atrial fibrillation ablation: incidence, predictors, and outcomes. Clin Res Cardiol 2024:10.1007/s00392-024-02467-6. [PMID: 38922425 DOI: 10.1007/s00392-024-02467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/16/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Although atrial fibrosis has a relevant impact on ablation success rate, experimental studies have reported that extensive fibrosis may be accompanied by a reduced burden secondary to a prominent depression of atrial excitability. OBJECTIVES We aimed to identify clinical and echocardiographic factors associated with extensive left atrial myopathy (ELAM), to analyze the predictive ability of established scores (AF score, APPLE, and DR-FLASH) and assess outcomes in terms of AF recurrence, left atrial flutter, and post-procedural heart failure admissions. METHODS A total of 950 consecutive patients undergoing the first AF ablation were included. A 3D electroanatomical mapping system (CARTO3, Biosense Webster) was created using a multipolar mapping catheter (PentaRay, Biosense Webster). ELAM was defined as ≥ 50% low voltage area. A subanalysis with four groups was also created (< 10%; 10-20%; 10-20%; and > 30%). Logistic regressions, Cox proportional hazards models, and log-rank test were used to test the predictors independently associated with the presence of ELAM and AF recurrence. The model was prospectively validated in a cohort of 150 patients obtaining an excellent ability for prediction AUC 0.90 (CI 95% 0.84-0.96). RESULTS Overall, 78 (8.42%) presented ELAM. Age, female sex, persistent AF, first-degree AV block, and E/e' were significant predictors. The model incorporating these factors outperformed the existing scores (AUC = 0.87). During a mean follow-up of 20 months (IQR 9 to 36), patients with ELAM presented a higher rate of AF recurrence (42.02% vs 26.01%, p = 0.030), left atrial flutter (26.03% vs 8.02%, p < 0.001), and post-procedural heart failure admissions (12.01% vs 0.61%, p < 0.001) than non-ELAM patients. CONCLUSIONS This study reveals the incidence and clinical factors associated with ELAM in AF, highlighting age, female, persistent AF, first-degree AV block, and E/e'. Importantly, the presence of ELAM is associated with poorer outcomes in terms of recurrence and HF admission.
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Affiliation(s)
- Teba González-Ferrero
- Division of Cardiac Electrophysiology, Department of Cardiology, University Hospital Lucus Augusti, Lugo, Spain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marco Bergonti
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
| | - Lorenzo Marcon
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Carlos Minguito-Carazo
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carlos Tilves Bellas
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
| | - Juan Carlos Pesquera Lorenzo
- Division of Cardiac Electrophysiology, Department of Cardiology, University Hospital Lucus Augusti, Lugo, Spain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Heart Rhythm Management Center, University Hospital of Brussels, Brussels, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - José Luis Martínez-Sande
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Laila González-Melchor
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Javier García-Seara
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jesús Alberto Fernández-López
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Center, University Hospital of Brussels, Brussels, Belgium
| | - Moisés Rodríguez-Mañero
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain.
- CIBERCV, Institute of Health Carlos III, Madrid, Spain.
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
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2
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Larsen BS, Aplin M, Høst N, Dominguez H, Christensen H, Christensen LM, Havsteen I, Prescott E, Jensen GB, Vejlstrup N, Bertelsen L, Sajadieh A. Atrial cardiomyopathy in patients with ischaemic stroke: a cross-sectional and prospective cohort study-the COAST study. BMJ Open 2022; 12:e061018. [PMID: 35545392 PMCID: PMC9096525 DOI: 10.1136/bmjopen-2022-061018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Despite workup for the aetiology of ischaemic stroke, about 25% of cases remain unexplained. Paroxysmal atrial fibrillation is typically suspected but often not detected. Even if atrial fibrillation (AF) is detected, the quantitative threshold of clinically relevant AF remains unclear. Emerging evidence suggests that left atrial (LA) functional and structural abnormalities may convey a risk of ischaemic stroke in which AF is only one of several features. These abnormalities have been termed 'atrial cardiomyopathy'. This study uses cardiac magnetic resonance (CMR) to evaluate atrial cardiomyopathy among patients with stroke of undetermined aetiology compared with those with an attributable mechanism and controls without established cardiovascular disease. METHODS AND ANALYSIS This cross-sectional and prospective cohort study included 100 patients with recent ischaemic stroke and 50 controls with no established cardiovascular disease. The study will assess LA structural and functional abnormalities with CMR. Inclusion began in March 2019, and follow-up is planned to be complete in January 2023. There are two scheduled follow-ups: (1) 18 months after individual inclusion, counting from the index diagnostic MRI of the brain, (2) end of study follow-up at 18 months after inclusion of the last patient, assessing the incidence of recurrent ischaemic stroke, AF and cardiovascular death. The primary endpoint is the extent of CMR-assessed atrial fibrosis in the LA at baseline. The study is powered to detect a difference of 6% fibrosis between stroke of undetermined aetiology and stroke of known mechanism with a SD of 9%, a significance level of 0.05, and power of 80%. ETHICS AND DISSEMINATION This study has been approved by the Danish National Committee on Health Research Ethics (H-18055313). All participants in the study signed informed consent. Results from the study will be published in peer-reviewed journals regardless of the outcome. TRIAL REGISTRATION NUMBER NCT03830983.
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Affiliation(s)
- Bjørn Strøier Larsen
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mark Aplin
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Helena Dominguez
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Louisa Marguerite Christensen
- Department of Neurology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Inger Havsteen
- Department of Radiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
| | - Gorm Boje Jensen
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Litten Bertelsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark
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3
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Mont L, Roca-Luque I, Althoff TF. Ablation Lesion Assessment with MRI. Arrhythm Electrophysiol Rev 2022; 11:e02. [PMID: 35444808 PMCID: PMC9014705 DOI: 10.15420/aer.2021.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Late gadolinium enhancement (LGE) MRI is capable of detecting not only native cardiac fibrosis, but also ablation-induced scarring. Thus, it offers the unique opportunity to assess ablation lesions non-invasively. In the atrium, LGE-MRI has been shown to accurately detect and localise gaps in ablation lines. With a negative predictive value close to 100% it can reliably rule out pulmonary vein reconnection non-invasively and thus may avoid unnecessary invasive repeat procedures where a pulmonary vein isolation only approach is pursued. Even LGE-MRI-guided repeat pulmonary vein isolation has been demonstrated to be feasible as a standalone approach. LGE-MRI-based lesion assessment may also be of value to evaluate the efficacy of ventricular ablation. In this respect, the elimination of LGE-MRI-detected arrhythmogenic substrate may serve as a potential endpoint, but validation in clinical studies is lacking. Despite holding great promise, the widespread use of LGE-MRI is still limited by the absence of standardised protocols for image acquisition and post-processing. In particular, reproducibility across different centres is impeded by inconsistent thresholds and internal references to define fibrosis. Thus, uniform methodological and analytical standards are warranted to foster a broader implementation in clinical practice.
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Affiliation(s)
- Lluís Mont
- Arrhythmia Section, Cardiovascular Institute, Clínic - University Hospital Barcelona Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Cardiovascular Institute, Clínic - University Hospital Barcelona Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Till F Althoff
- Arrhythmia Section, Cardiovascular Institute, Clínic - University Hospital Barcelona Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Department of Cardiology and Angiology, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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4
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Chahine Y, Askari-Atapour B, Kwan KT, Anderson CA, Macheret F, Afroze T, Bifulco SF, Cham MD, Ordovas K, Boyle PM, Akoum N. Epicardial adipose tissue is associated with left atrial volume and fibrosis in patients with atrial fibrillation. Front Cardiovasc Med 2022; 9:1045730. [PMID: 36386377 PMCID: PMC9664066 DOI: 10.3389/fcvm.2022.1045730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Background Obesity is a risk factor for atrial fibrillation (AF) and strongly influences the response to treatment. Atrial fibrosis shows similar associations. Epicardial adipose tissue (EAT) may be a link between these associations. We sought to assess whether EAT is associated with body mass index (BMI), left atrial (LA) fibrosis and volume. Methods LA fibrosis and EAT were assessed using late gadolinium enhancement, and Dixon MRI sequences, respectively. We derived 3D models incorporating fibrosis and EAT, then measured the distance of fibrotic and non-fibrotic areas to the nearest EAT to assess spatial colocalization. Results One hundred and three AF patients (64% paroxysmal, 27% female) were analyzed. LA volume index was 54.9 (41.2, 69.7) mL/m2, LA EAT index was 17.4 (12.7, 22.9) mL/m2, and LA fibrosis was 17.1 (12.4, 23.1)%. LA EAT was significantly correlated with BMI (R = 0.557, p < 0.001); as well as with LA volume and LA fibrosis after BSA adjustment (R = 0.579 and R = 0.432, respectively, p < 0.001 for both). Multivariable analysis showed LA EAT to be independently associated with LA volume and fibrosis. 3D registration of fat and fibrosis around the LA showed no clear spatial overlap between EAT and fibrotic LA regions. Conclusion LA EAT is associated with obesity (BMI) as well as LA volume and fibrosis. Regions of LA EAT did not colocalize with fibrotic areas, suggesting a systemic or paracrine mechanism rather than EAT infiltration of fibrotic areas.
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Affiliation(s)
- Yaacoub Chahine
- Division of Cardiology, University of Washington, Seattle, WA, United States
| | | | - Kirsten T Kwan
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Carter A Anderson
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Fima Macheret
- Division of Cardiology, University of Washington, Seattle, WA, United States
| | - Tanzina Afroze
- Division of Cardiology, University of Washington, Seattle, WA, United States
| | - Savannah F Bifulco
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Matthew D Cham
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Karen Ordovas
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Patrick M Boyle
- Department of Bioengineering, University of Washington, Seattle, WA, United States.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, United States.,Center for Cardiovascular Biology, University of Washington, Seattle, WA, United States
| | - Nazem Akoum
- Division of Cardiology, University of Washington, Seattle, WA, United States.,Department of Bioengineering, University of Washington, Seattle, WA, United States
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5
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Hopman LHGA, Mulder MJ, van der Laan AM, Demirkiran A, Bhagirath P, van Rossum AC, Allaart CP, Götte MJW. Impaired left atrial reservoir and conduit strain in patients with atrial fibrillation and extensive left atrial fibrosis. J Cardiovasc Magn Reson 2021; 23:131. [PMID: 34758820 PMCID: PMC8582184 DOI: 10.1186/s12968-021-00820-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with profound structural and functional changes in the atria. In the present study, we investigated the association between left atrial (LA) phasic function and the extent of LA fibrosis using advanced cardiovascular magnetic resonance (CMR) imaging techniques, including 3-dimensional (3D) late gadolinium enhancement (LGE) and feature tracking. METHODS Patients with paroxysmal and persistent AF (n = 105) underwent CMR in sinus rhythm. LA global reservoir strain, conduit strain and contractile strain were derived from cine CMR images using CMR feature tracking. The extent of LA fibrosis was assessed from 3D LGE images. Healthy subjects underwent CMR and served as controls (n = 19). RESULTS Significantly lower LA reservoir strain, conduit strain and contractile strain were found in AF patients, as compared to healthy controls (- 15.9 ± 3.8% vs. - 21.1 ± 3.6% P < 0.001, - 8.7 ± 2.7% vs. - 12.6 ± 2.5% P < 0.001 and - 7.2 ± 2.3% vs. - 8.6 ± 2.2% P = 0.02, respectively). Patients with a high degree of LA fibrosis (dichotomized by the median value) had lower reservoir strain and conduit strain compared to patients with a low degree of LA fibrosis (- 15.0 ± 3.9% vs. - 16.9 ± 3.3%, P = 0.02 and - 7.9 ± 2.7% vs. - 9.5 ± 2.6%, P = 0.01, respectively). In contrast, no difference was found for LA contractile strain (- 7.1 ± 2.4% vs. - 7.4 ± 2.3%, P = 0.55). CONCLUSIONS Impaired LA reservoir and conduit strain are present in AF patients with extensive atrial fibrosis. Future studies are needed to examine the biologic nature of this association and possible therapeutic implications.
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Affiliation(s)
- Luuk H. G. A. Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Mark J. Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Anja M. van der Laan
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Marco J. W. Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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6
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Wu Z, Liu Y, Tong L, Dong D, Deng D, Xia L. Current progress of computational modeling for guiding clinical atrial fibrillation ablation. J Zhejiang Univ Sci B 2021; 22:805-817. [PMID: 34636185 DOI: 10.1631/jzus.b2000727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias, associated with high morbidity, mortality, and healthcare costs, and it places a significant burden on both individuals and society. Anti-arrhythmic drugs are the most commonly used strategy for treating AF. However, drug therapy faces challenges because of its limited efficacy and potential side effects. Catheter ablation is widely used as an alternative treatment for AF. Nevertheless, because the mechanism of AF is not fully understood, the recurrence rate after ablation remains high. In addition, the outcomes of ablation can vary significantly between medical institutions and patients, especially for persistent AF. Therefore, the issue of which ablation strategy is optimal is still far from settled. Computational modeling has the advantages of repeatable operation, low cost, freedom from risk, and complete control, and is a useful tool for not only predicting the results of different ablation strategies on the same model but also finding optimal personalized ablation targets for clinical reference and even guidance. This review summarizes three-dimensional computational modeling simulations of catheter ablation for AF, from the early-stage attempts such as Maze III or circumferential pulmonary vein isolation to the latest advances based on personalized substrate-guided ablation. Finally, we summarize current developments and challenges and provide our perspectives and suggestions for future directions.
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Affiliation(s)
- Zhenghong Wu
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Yunlong Liu
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Lv Tong
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Diandian Dong
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Dongdong Deng
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Ling Xia
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China.
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7
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Li G, Zhao C, Fang S. SGLT2 promotes cardiac fibrosis following myocardial infarction and is regulated by miR-141. Exp Ther Med 2021; 22:715. [PMID: 34007324 PMCID: PMC8120516 DOI: 10.3892/etm.2021.10147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiac fibrosis is a primary event during myocardial infarction (MI) progression, which impairs cardiac function. The present study aimed to investigate the effect of SGLT2 on cardiac fibrosis following MI. To validate the role of SGLT2 in the regulation of cardiac fibrosis in vivo, an MI rat model was established. Echocardiography was performed to determine cardiac function at 4 weeks post-MI. MI model rats were transfected with short hairpin RNA (sh)-SGLT2 or sh-negative control lentiviruses to investigate the effect of SGLT2 on rat heart function post-MI. Subsequently, the effects of SGLT2 on the cardiac fibrosis of infarcted hearts were assessed by performing Masson's trichrome staining. To further clarify the effect of SGLT2 on cardiac fibroblast proliferation, TGFβ was used to stimulate primary cardiac fibroblasts in vitro. The results demonstrated that SGLT2 served a key role in cardiac fibrosis. SGLT2 expression levels in infarct tissues were significantly increased at week 1 post-MI compared with the sham group. Compared with the control group, SGLT2 knockdown attenuated cardiac fibrosis by inhibiting the expression of collagen I and collagen III in cardiac fibroblasts in vitro and in vivo. Furthermore, the results indicated that SGLT2 expression was modulated by miR-141 in cardiac fibroblasts. In summary, the present study indicated that upregulated SGLT2 expression in cardiac fibrosis following MI was regulated by miR-141 and SGLT2 that knockdown reduced cardiac fibrosis and improved cardiac function after MI.
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Affiliation(s)
- Gang Li
- Department of Geriatrics, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Congchun Zhao
- Department of Geriatrics, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Shanhua Fang
- Department of Geriatrics, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241000, P.R. China
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8
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Mandoli GE, D'Ascenzi F, Vinco G, Benfari G, Ricci F, Focardi M, Cavigli L, Pastore MC, Sisti N, De Vivo O, Santoro C, Mondillo S, Cameli M. Novel Approaches in Cardiac Imaging for Non-invasive Assessment of Left Heart Myocardial Fibrosis. Front Cardiovasc Med 2021; 8:614235. [PMID: 33937354 PMCID: PMC8081830 DOI: 10.3389/fcvm.2021.614235] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
In the past, the identification of myocardial fibrosis was only possible through invasive histologic assessment. Although endomyocardial biopsy remains the gold standard, recent advances in cardiac imaging techniques have enabled non-invasive tissue characterization of the myocardium, which has also provided valuable insights into specific disease processes. The diagnostic accuracy, incremental yield and prognostic value of speckle tracking echocardiography, late gadolinium enhancement and parametric mapping modules by cardiac magnetic resonance and cardiac computed tomography have been validated against tissue samples and tested in broad patient populations, overall providing relevant clinical information to the cardiologist. This review describes the patterns of left ventricular and left atrial fibrosis, and their characterization by advanced echocardiography, cardiac magnetic resonance and cardiac computed tomography, allowing for clinical applications in sudden cardiac death and management of atrial fibrillation.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Vinco
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Department of Clinical Sciences, Lund University, Malmö, Sweden.,Casa di Cura Villa Serena, Città Sant'Angelo, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicolò Sisti
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Oreste De Vivo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Ali RL, Qureshi NA, Liverani S, Roney CH, Kim S, Lim PB, Tweedy JH, Cantwell CD, Peters NS. Left Atrial Enhancement Correlates With Myocardial Conduction Velocity in Patients With Persistent Atrial Fibrillation. Front Physiol 2020; 11:570203. [PMID: 33304272 PMCID: PMC7693630 DOI: 10.3389/fphys.2020.570203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Conduction velocity (CV) heterogeneity and myocardial fibrosis both promote re-entry, but the relationship between fibrosis as determined by left atrial (LA) late-gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMRI) and CV remains uncertain. OBJECTIVE Although average CV has been shown to correlate with regional LGE-CMRI in patients with persistent AF, we test the hypothesis that a localized relationship exists to underpin LGE-CMRI as a minimally invasive tool to map myocardial conduction properties for risk stratification and treatment guidance. METHOD 3D LA electroanatomic maps during LA pacing were acquired from eight patients with persistent AF following electrical cardioversion. Local CVs were computed using triads of concurrently acquired electrograms and were co-registered to allow correlation with LA wall intensities obtained from LGE-CMRI, quantified using normalized intensity (NI) and image intensity ratio (IIR). Association was evaluated using multilevel linear regression. RESULTS An association between CV and LGE-CMRI intensity was observed at scales comparable to the size of a mapping electrode: -0.11 m/s per unit increase in NI (P < 0.001) and -0.96 m/s per unit increase in IIR (P < 0.001). The magnitude of this change decreased with larger measurement area. Reproducibility of the association was observed with NI, but not with IIR. CONCLUSION At clinically relevant spatial scales, comparable to area of a mapping catheter electrode, LGE-CMRI correlates with CV. Measurement scale is important in accurately quantifying the association of CV and LGE-CMRI intensity. Importantly, NI, but not IIR, accounts for changes in the dynamic range of CMRI and enables quantitative reproducibility of the association.
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Affiliation(s)
- Rheeda L. Ali
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Norman A. Qureshi
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Silvia Liverani
- School of Mathematical Sciences, Queen Mary University of London, London, United Kingdom
| | - Caroline H. Roney
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Steven Kim
- Abbot Medical, St. Paul, MN, United States
| | - P. Boon Lim
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Jennifer H. Tweedy
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Chris D. Cantwell
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- Department of Aeronautics, Imperial College London, London, United Kingdom
| | - Nicholas S. Peters
- ElectroCardioMaths Programme of The Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
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10
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Gunasekaran S, Haji-Valizadeh H, Lee DC, Avery RJ, Wilson BD, Ibrahim M, Markl M, Passman RS, Kholmovski EG, Kim D. Accelerated 3D Left Atrial Late Gadolinium Enhancement in Patients with Atrial Fibrillation at 1.5 T: Technical Development. Radiol Cardiothorac Imaging 2020; 2:e200134. [PMID: 33154994 PMCID: PMC7605361 DOI: 10.1148/ryct.2020200134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To develop an accelerated three-dimensional (3D) late gadolinium enhancement (LGE) pulse sequence using balanced steady-state free precession readout with stack-of-stars k-space sampling and extra motion-state golden-angle radial sparse parallel (XD-GRASP) reconstruction and test the performance for detecting atrial scar and fibrosis in patients with atrial fibrillation (AF). MATERIALS AND METHODS Twenty-five patients with AF (20 paroxysmal and five persistent; 65 years ± 7 [standard deviation]; 18 men) were imaged at 1.5 T using the proposed LGE sequence with 1.3 mm × 1.3 mm × 2-mm spatial resolution and predictable imaging time. The resulting images were compared with historic images of 25 patients with AF (18 paroxysmal and seven persistent; 67 years ± 10; 14 men) obtained using a reference 3D left atrial (LA) LGE sequence with 1.3 mm × 1.3 mm × 2.5-mm spatial resolution. Two readers visually graded the 3D LGE images (conspicuity, artifact, noise) on a five-point Likert scale (1 = worst, 3 = acceptable, 5 = best), in which the summed visual score (SVS) of 9 or greater was defined as clinically acceptable. Appropriate statistical analyses (Cohen κ coefficient, Mann-Whitney U test, t tests, and intraclass correlation) were performed, where a P value < .05 was considered significant. RESULTS Mean imaging time was significantly shorter (P < .01) for the proposed pulse sequence (5.9 minutes ± 1.3) than for the reference pulse sequence (10.6 minutes ± 2). Median SVS was significantly higher (P < .01) for the proposed (SVS = 11) than reference (SVS = 9.5) 3D LA LGE images. Interrater reproducibility in visual scores was higher for the proposed (κ = 0.78-1) than reference 3D LA LGE (κ = 0.44-0.75). Intrareader repeatability in fibrosis quantification was higher for the reference cohort (intraclass correlation coefficient [ICC] = 0.94) than the prospective cohort (ICC = 0.79). CONCLUSION The proposed 3D LA LGE method produced clinically acceptable image quality with 1.5 mm × 1.5 mm × 2-mm nominal spatial resolution and 6-minute predictable imaging time for quantification of LA scar and fibrosis in patients with AF. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Suvai Gunasekaran
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
| | - Hassan Haji-Valizadeh
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
| | - Daniel C. Lee
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
| | - Ryan J. Avery
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
| | - Brent D. Wilson
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
| | - Mark Ibrahim
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
| | - Michael Markl
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
| | - Rod S. Passman
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
| | - Eugene G. Kholmovski
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
| | - Daniel Kim
- From the Department of Radiology (S.G., D.C.L., R.J.A., M.M., D.K.) and Department of Internal Medicine, Division of Cardiology (D.C.L., R.S.P.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, Ill (S.G., M.M., D.K.); Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (H.H.V.); and Department of Internal Medicine, Division of Cardiovascular Medicine (B.D.W., M.I.), and Department of Radiology and Imaging Sciences (E.G.K.), University of Utah, Salt Lake City, Utah
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11
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The Value of Voltage Histogram Analysis Derived Right Atrial Scar Burden in the Prediction of Left Atrial Scar Burden. Cardiol Res Pract 2020; 2020:3981684. [PMID: 32855820 PMCID: PMC7442993 DOI: 10.1155/2020/3981684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Growing evidence suggests that fibrotic changes can be observed in atrial fibrillation (AF) in both atria. Quantification of the scar burden during electroanatomical mapping might have important therapeutic and prognostic consequences. However, as the current invasive treatment of AF is focused on the left atrium (LA), the role of the right atrium (RA) is less well understood. We aimed to characterize the clinical determinates of the RA low-voltage burden and its relation to the LA scaring. Methods We have included 36 patients who underwent catheter ablation for AF in a prospective observational study. In addition to LA mapping and ablation, high-density RA bipolar voltage maps (HD-EAM) were also reconstructed. The extent of the diseased RA tissue (≤0.5 mV) was quantified using the voltage histogram analysis tool (CARTO®3, Biosense Webster). Results The percentage of RA diseased tissue burden was significantly higher in patients with a CHA2DS2-VASc score ≥ 2 (p = 0.0305), higher indexed LA volume on the CTA scan and on the HD‐EAM (p = 0.0223 and p = 0.0064, respectively), or higher indexed RA volume on the HD‐EAM (p = 0.0026). High RA diseased tissue burden predicted the presence of high LA diseased tissue burden (OR = 7.1, CI (95%): 1.3–38.9, p = 0.0145), and there was a significant correlation of the same (r = 0.6461, p < 0.0001). Conclusions Determining the extent of the right atrial low-voltage burden might give useful clinical information. According to our results, the diseased tissue burden correlates well between the two atria: the right atrium mirrors the left atrium.
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Bertelsen L, Alarcón F, Andreasen L, Benito E, Olesen MS, Vejlstrup N, Mont L, Svendsen JH. Verification of threshold for image intensity ratio analyses of late gadolinium enhancement magnetic resonance imaging of left atrial fibrosis in 1.5T scans. Int J Cardiovasc Imaging 2019; 36:513-520. [PMID: 31748945 PMCID: PMC7080681 DOI: 10.1007/s10554-019-01728-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/03/2019] [Indexed: 11/25/2022]
Abstract
The use of cardiovascular magnetic resonance imaging left atrial late gadolinium enhancement (LA LGE) is increasing for fibrosis evaluation though the use is still limited to specialized centres due to complex image acquisition and lack of consensus on image analyses. Analysis of LA LGE with image intensity ratio (IIR) (pixel intensity of atrial wall normalized by blood pool intensity) provides an objective method to obtain quantitative data on atrial fibrosis. A threshold between healthy myocardium and fibrosis of 1.2 has previously been established in 3T scans. The aim of the study was to reaffirm this threshold in 1.5T scans. LA LGE was performed using a 1.5T magnetic resonance scanner on: 11 lone-AF patients, 11 age-matched healthy volunteers (aged 27-44) and 11 elderly patients without known history of AF but varying degrees of comorbidities. Mean values of IIR for all healthy volunteers +2SD were set as upper limit of normality and was reproduced to 1.21 and the original IIR-threshold of 1.20 was maintained. The degree of fibrosis in lone-AF patients [median 9.0% (IQR 3.9-12.0)] was higher than in healthy volunteers [2.8% (1.3-8.3)] and even higher in elderly non-AF [20.1% (10.2-35.8), p = 0.001]. The previously established IIR-threshold of 1.2 was reaffirmed in 1.5T LA LGE scans. Patients with lone AF presented with increased degrees of atrial fibrosis compared to healthy volunteers in the same age-range. Elderly patients with no history of AF showed significantly higher degrees of fibrosis compared to both groups with younger individuals.
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Affiliation(s)
- Litten Bertelsen
- Department of Cardiology, Centre for Cardiac-, Vascular-, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Francisco Alarcón
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA) Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Andreasen
- Department of Cardiology, Centre for Cardiac-, Vascular-, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva Benito
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA) Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Niels Vejlstrup
- Department of Cardiology, Centre for Cardiac-, Vascular-, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lluis Mont
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA) Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Centre for Cardiac-, Vascular-, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Li L, Wu F, Yang G, Xu L, Wong T, Mohiaddin R, Firmin D, Keegan J, Zhuang X. Atrial scar quantification via multi-scale CNN in the graph-cuts framework. Med Image Anal 2019; 60:101595. [PMID: 31811981 PMCID: PMC6988106 DOI: 10.1016/j.media.2019.101595] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/05/2019] [Accepted: 10/26/2019] [Indexed: 11/06/2022]
Abstract
Propose a fully automatic method for left atrial scar quantification, with promising performance. Formulate a new framework of scar quantification based on surface projection and graph-cuts framework. Propose the multi-scale learning CNN, combined with the random shift training strategy, to learn and predict the graph potentials, which significantly improves the performance of the proposed method, and enables the full automation of the framework. Provide thorough validation and parameter studies for the proposed techniques using fifty-eight clinical images.
Late gadolinium enhancement magnetic resonance imaging (LGE MRI) appears to be a promising alternative for scar assessment in patients with atrial fibrillation (AF). Automating the quantification and analysis of atrial scars can be challenging due to the low image quality. In this work, we propose a fully automated method based on the graph-cuts framework, where the potentials of the graph are learned on a surface mesh of the left atrium (LA) using a multi-scale convolutional neural network (MS-CNN). For validation, we have included fifty-eight images with manual delineations. MS-CNN, which can efficiently incorporate both the local and global texture information of the images, has been shown to evidently improve the segmentation accuracy of the proposed graph-cuts based method. The segmentation could be further improved when the contribution between the t-link and n-link weights of the graph is balanced. The proposed method achieves a mean accuracy of 0.856 ± 0.033 and mean Dice score of 0.702 ± 0.071 for LA scar quantification. Compared to the conventional methods, which are based on the manual delineation of LA for initialization, our method is fully automatic and has demonstrated significantly better Dice score and accuracy (p < 0.01). The method is promising and can be potentially useful in diagnosis and prognosis of AF.
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Affiliation(s)
- Lei Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; School of Data Science, Fudan University, Shanghai, China
| | - Fuping Wu
- School of Data Science, Fudan University, Shanghai, China; Dept of Statistics, School of Management, Fudan University, Shanghai, China
| | - Guang Yang
- National Heart and Lung Institute, Imperial College London, London, UK; Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - Lingchao Xu
- School of NAOCE, Shanghai Jiao Tong University, Shanghai, China
| | - Tom Wong
- Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - Raad Mohiaddin
- National Heart and Lung Institute, Imperial College London, London, UK; Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - David Firmin
- National Heart and Lung Institute, Imperial College London, London, UK; Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - Jennifer Keegan
- National Heart and Lung Institute, Imperial College London, London, UK; Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China; Fudan-Xinzailing Joint Research Center for Big Data, Fudan University, Shanghai, China.
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14
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Ghannam M, Oral H. Mapping and Imaging in Non-paroxysmal AF. Arrhythm Electrophysiol Rev 2019; 8:202-209. [PMID: 31463058 PMCID: PMC6702463 DOI: 10.15420/aer.2019.18.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/25/2019] [Indexed: 01/22/2023] Open
Abstract
Despite intense research efforts, maintenance of sinus rhythm in patients with non-paroxysmal AF remains challenging with suboptimal outcomes. A major limitation to the success of current ablation-based treatments is that our understanding of AF pathophysiology is incomplete. Advances in imaging and mapping tools have been reported to improve ablation outcomes. However, the role of these new approaches on the clinical care of patients with AF remains to be validated and better understood before wide adoption can occur. This article reviews the current techniques of imaging and mapping that can be applied in the management of patients with non-paroxysmal AF with a focus on their relevance to catheter ablation. Future applications and opportunities for new knowledge are also discussed.
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Affiliation(s)
- Michael Ghannam
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan Ann Arbor, MI, US
| | - Hakan Oral
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan Ann Arbor, MI, US
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15
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Benito EM, Alarcon F, Mont L. LGE-MRI Characterization of Left Atrial Fibrosis: a Tool to Establish Prognosis and Guide Atrial Fibrillation Ablation. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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Stiles MK, Sanders P, Lau DH. Targeting the Substrate in Ablation of Persistent Atrial Fibrillation: Recent Lessons and Future Directions. Front Physiol 2018; 9:1158. [PMID: 30279660 PMCID: PMC6154526 DOI: 10.3389/fphys.2018.01158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/02/2018] [Indexed: 12/16/2022] Open
Abstract
While isolation of the pulmonary veins is firmly established as effective treatment for the majority of paroxysmal atrial fibrillation (AF) patients, there is recognition that patients with persistent AF have substrate for perpetuation of arrhythmia existing outside of the pulmonary veins. Various computational approaches have been used to identify targets for effective ablation of persistent AF. This paper aims to discuss the clinical aspects of computational approaches that aim to identify critical sites for treatment. Various analyses of electrogram characteristics have been performed with this aim. Leading techniques for electrogram analysis are Complex Fractionated Atrial Electrograms (CFAE) and Dominant Frequency (DF). These techniques have been the subject of clinical trials of which the results are discussed. Evaluation of the activation patterns of atria in AF has been another avenue of research. Focal Impulse and Rotor Modulation (FIRM) mapping and forms of Body Surface Mapping aim to characterize multiple atrial wavelets, macro-reentry and focal sources which have been proposed as basic mechanisms perpetuating AF. Both invasive and non-invasive activation mapping techniques are reviewed. The presence of atrial fibrosis causes non-uniform anisotropic impulse propagation. Therefore, identification of fibrosis by imaging techniques is an avenue of potential research. The leading contender for imaging-based techniques is Cardiac Magnetic Resonance (CMR). As this technology advances, improvements in resolution and scar identification have positioned CMR as the mode of choice for analysis of atrial structure. AF has been demonstrated to be associated with obesity, inactivity and diseases of modern life. An opportunity exists for detailed computational analysis of the impact of risk factor modification on atrial substrate. This ranges from microstructural investigation through to examination at a population level via registries and public health interventions. Computational analysis of atrial substrate has moved from basic science toward clinical application. Future directions and potential limitations of such analyses are examined in this review.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand.,Department of Cardiology, Waikato District Health Board, Hamilton, New Zealand
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
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Baranchuk A, Alexander B, Cinier G, Martinez-Selles M, Tekkesin AI, Elousa R, De Luna AB. Bayés' syndrome: Time to consider early anticoagulation? North Clin Istanb 2018; 5:370-378. [PMID: 30815636 PMCID: PMC6372001 DOI: 10.14744/nci.2017.60251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/10/2017] [Indexed: 12/26/2022] Open
Abstract
In the past few decades, extensive research has been conducted on atrial conduction disorders and their clinical relevance. An association between interatrial block (IAB) and supraventricular arrhythmias [most commonly atrial fibrillation (AF)] has been discovered and extensively investigated. We coined the term "Bayés Syndrome" to describe this association, and the medical community has accepted the eponym in recognition to the scientist who discovered most of the aspects associated with it. In this non-systematic review, we will focus on the association between IAB and AF, with special emphasis on the value of the surface 12-lead ECG as a valid tool to predict AF.
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Affiliation(s)
- Adrian Baranchuk
- Department of Cardiology, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
| | - Bryce Alexander
- Department of Cardiology, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
| | - Goksel Cinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Manuel Martinez-Selles
- Department of Cardiology, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Ahmet Ilker Tekkesin
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Roberto Elousa
- Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, Barcelona, Spain
| | - Antoni Bayes De Luna
- Department of Cardiology, Hospital del Mar Medical Research Institute, Barcelona, Spain
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18
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Zhao J, Hansen BJ, Wang Y, Csepe TA, Sul LV, Tang A, Yuan Y, Li N, Bratasz A, Powell KA, Kilic A, Mohler PJ, Janssen PML, Weiss R, Simonetti OP, Hummel JD, Fedorov VV. Three-dimensional Integrated Functional, Structural, and Computational Mapping to Define the Structural "Fingerprints" of Heart-Specific Atrial Fibrillation Drivers in Human Heart Ex Vivo. J Am Heart Assoc 2017; 6:JAHA.117.005922. [PMID: 28862969 PMCID: PMC5586436 DOI: 10.1161/jaha.117.005922] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Structural remodeling of human atria plays a key role in sustaining atrial fibrillation (AF), but insufficient quantitative analysis of human atrial structure impedes the treatment of AF. We aimed to develop a novel 3-dimensional (3D) structural and computational simulation analysis tool that could reveal the structural contributors to human reentrant AF drivers. METHODS AND RESULTS High-resolution panoramic epicardial optical mapping of the coronary-perfused explanted intact human atria (63-year-old woman, chronic hypertension, heart weight 608 g) was conducted during sinus rhythm and sustained AF maintained by spatially stable reentrant AF drivers in the left and right atrium. The whole atria (107×61×85 mm3) were then imaged with contrast-enhancement MRI (9.4 T, 180×180×360-μm3 resolution). The entire 3D human atria were analyzed for wall thickness (0.4-11.7 mm), myofiber orientations, and transmural fibrosis (36.9% subendocardium; 14.2% midwall; 3.4% subepicardium). The 3D computational analysis revealed that a specific combination of wall thickness and fibrosis ranges were primarily present in the optically defined AF driver regions versus nondriver tissue. Finally, a 3D human heart-specific atrial computer model was developed by integrating 3D structural and functional mapping data to test AF induction, maintenance, and ablation strategies. This 3D model reproduced the optically defined reentrant AF drivers, which were uninducible when fibrosis and myofiber anisotropy were removed from the model. CONCLUSIONS Our novel 3D computational high-resolution framework may be used to quantitatively analyze structural substrates, such as wall thickness, myofiber orientation, and fibrosis, underlying localized AF drivers, and aid the development of new patient-specific treatments.
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Affiliation(s)
- Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Brian J Hansen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Yufeng Wang
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Thomas A Csepe
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lidiya V Sul
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alan Tang
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Yiming Yuan
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Ning Li
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Anna Bratasz
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kimerly A Powell
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ahmet Kilic
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J Mohler
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul M L Janssen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Raul Weiss
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Orlando P Simonetti
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - John D Hummel
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH .,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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19
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Abstract
In the last twenty years, new imaging techniques to assess atrial function and to predict the risk of recurrence of atrial fibrillation after treatment have been developed. The present review deals with the role of these techniques in the detection of structural and functional changes of the atrium and diagnosis of atrial remodeling, particularly atrial fibrosis. Echocardiography allows the detection of anatomical, functional changes and deformation of the atrial wall during the phases of the cardiac cycle. For this, adequate acquisition of atrial images is necessary using speckle tracking imaging and interpretation of the resulting strain and strain rate curves. This allows to predict new-onset atrial fibrillation and recurrences. Its main limitations are inter-observer variability, the existence of different software manufacturers, and the fact that the software used were originally developed for the evaluation of the ventricular function and are now applied to the atria. Cardiac magnetic resonance, using contrast enhancement with gadolinium, plays a key role in the visualization and quantification of atrial fibrosis. This is the established method for in vivo visualization of myocardial fibrotic tissue. The non-invasive evaluation of atrial fibrosis is associated with the risk of recurrence of atrial fibrillation and with electro-anatomical endocardial mapping. We discuss the limitations of these techniques, derived from the difficulty of demonstrating the correlation between fibrosis imaging and histology, and poor intra- and inter-observer reproducibility. The sources of discordance are described, mainly due to image acquisition and processing, and the challenges ahead in an attempt to eliminate differences between operators.
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20
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Nam JH, Lee CH. Giant Right Atrial Aneurysm ― Multimodality Imaging ―. Circ J 2017; 81:415-416. [DOI: 10.1253/circj.cj-16-0964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jong-Ho Nam
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center
| | - Chan-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center
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