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  • Open Access

Assessment of left atrial systolic dyssynchrony in paroxysmal atrial fibrillation and heart failure using cardiac magnetic resonance imaging: MESA study

  • 1, 2,
  • 1,
  • 6,
  • 1,
  • 1,
  • 1,
  • 5,
  • 4,
  • 3,
  • 4,
  • 3 and
  • 1
Journal of Cardiovascular Magnetic Resonance201517 (Suppl 1) :P322

https://doi.org/10.1186/1532-429X-17-S1-P322

  • Published:

Keywords

  • Cardiac Magnetic Resonance
  • Left Atrial
  • Paroxysmal Atrial Fibrillation
  • Peak Systolic Strain
  • Longitudinal Strain Rate

Background

Left atrial (LA) remodeling in response to cardiovascular and hemodynamic stress may precede atrial fibrillation (AF) and heart failure (HF). We hypothesized that LA systolic synchronous contraction as a functional measure of LA remodeling is deranged in patients with paroxysmal AF and HF.

Methods

We performed a nested case-control analysis with 1:2 matching for 39 cases of paroxysmal AF (n=28, in sinus rhythm during cardiac magnetic resonance (CMR)) and HF (n=14, AF+HF; n=3) and 78 controls with similar demographic and clinical characteristics at the baseline (Table 1). LA circumferential (short axis) and longitudinal strain rate (horizontal long axis) were measured using Multi-modality Tissue Tracking (Toshiba, Japan) from short and long-axis cine CMR images. Circumferential LA systolic dyssynchrony among 18 LA segments (6 segments x 3 slices) was evaluated as; Standard Deviation (SD) of time to pre atrial contraction Strain rate (PreA Src) and Peak systolic strain rate (Peak Srac) (Figure 1). Similarly, longitudinal LA dyssynchrony parameters (among 6 segments) were: SD-Time to pre-atrial contraction strain rate (PreA SrL) and SD-Time to peak systolic strain rate (Peak-SraL). Wilcoxon-rank sum test (non-parametric) or two sample t-test (parametric) were used for comparison between the groups.
Table 1

Left atrial circumferential and longitudinal systolic dyssynchrony parameters among the cases and the control group.

Parameters

Controls (n=78)

Cases (n=39) (paroxysmal AF + Heart Failure)

p-value

Longitudinal

Mean ±SD

Median

IQR

Mean ±SD

Median

IQR

 

SD-TP PreA SrL, msec

36.43 ± 33.53

27.40

15.50 - 46.13

51.62 ± 33.40

39.70

32.07 - 61.78

0.001

SD-TP Peak SraL

35.92 ± 43.22

23.86

16.32 - 35.60

45.23 ± 42.04

32.50

22.98 - 44.54

0.027

Circumferential

       

SD-TP PreA Src, msec

28.73±13.90

26.23

19.70 - 34.98

45.06 ± 30.25

35.49

24.84 - 57.03

0.010

SD-TP Peak Srac, msec

28.95 ± 23.1

23.04

16.46 - 31.57

36.46 ± 30.93

26.83

17.45 - 44.02

0.316

LA maximum volume/BSA

33.79 ± 9.57

31.72

28.64 - 38.86

45.02 ± 17.85

44.38

31.04 - 56.44

<0.0001

Sra (%/ms)

-1.85 ± 0.85

-1.74

-2.18: -1.45

-1.03 ± 0.61

-1.04

-1.04: -0.53

<0.0001

Participants were matched for: Age, gender, race/ethnicity.

Figure 1
Figure 1

LA circumferential (panel A) and longitudinal (panel B) strain rate curves during a cardiac cycle using multimodality tissue tracking.

Results

In participants during MESA exam 5 (age 74±8 years, 51.4% men), systolic circumferential dyssynchrony (SD-TP-PreA Src, msec) was significantly higher in the cases compared to controls (45.06 vs. 28.73, p<0.010). Similarly, case group had greater longitudinal dyssynchrony than controls; SD-TP PreA SrL (51.62 vs. 36.43, p=0.001) and SD-TP-Peak SraL (45.23 vs. 35.92, p=0.027) (Table 1).

Conclusions

Patients with paroxysmal atrial fibrillation and heart failure have significantly higher LA circumferential and longitudinal systolic dyssynchrony compared to normal controls.

Funding

N/A.

Authors’ Affiliations

(1)
Johns Hopkins, Baltimore, MD, USA
(2)
Universidade federal da Bahia, Salvador, Brazil
(3)
National Institutes of Health, Bethesda, MD, USA
(4)
University of Washington, Washington, DC, USA
(5)
Columbia University, New York, NY, USA
(6)
Union memorial Hospital, Baltimore, MD, USA

Copyright

© Ciuffo et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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