Dataset Information

Association between Left Atrial Late Gadolinium Enhancement and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA).

ABSTRACT:

Purpose

To determine the prevalence and correlates of left atrial (LA) late gadolinium enhancement (LGE) at cardiac MRI and its association with atrial fibrillation (AF) in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA).

Materials and methods

In this secondary post hoc analysis of the MESA cohort (ClinicalTrials.gov no. NCT00005487), participants without AF underwent LGE cardiac MRI at the fifth examination (2010-2012). LA LGE burden was quantified using the image intensity ratio technique on biplane long-axis two-dimensional (2D) LGE images without fat saturation. Survival analysis was performed with log-rank testing and Cox regression.

Results

Of 1697 participants (mean age, 67 years ± 9 [SD]; 872 men), 1035 (61%) had LA LGE, and 75 (4.4%) developed AF during follow-up (median, 3.95 years). At univariable analysis, LA LGE was associated with age (β = .010 [95% CI: .005, .015], P < .001), diastolic blood pressure (β = .005 [95% CI: .001, .009], P = .02), HbA1c level (β = .06 [95% CI: .02, .11], P = .009), heart failure (β = .60 [95% CI: .11, 1.08], P = .02), LA volume (β = .008 [95% CI: .004, .012], P < .001), and LA function (emptying fraction, LA global longitudinal strain, LA early diastolic peak longitudinal strain rate, and LA late diastolic peak strain rate; all P < .05). After adjusting for the variables in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) AF score, LA LGE independently helped predict incident AF (hazard ratio = 1.46 [95% CI: 1.13, 1.88], P = .003). The highest tertile (LGE > 2%) was twice as likely to develop AF.

Conclusion

Although limited by the 2D LGE technique employed, LA LGE was associated with adverse atrial remodeling and helped predict AF in a multiethnic population-based sample.Clinical trial registration no. NCT00005487Keywords: MR Imaging, Cardiac, Epidemiology Supplemental material is available for this article. © RSNA, 2023.

SUBMITTER: Zghaib T

PROVIDER: S-EPMC10483245 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Association between Left Atrial Late Gadolinium Enhancement and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA).

Zghaib Tarek T Quinaglia A C Silva Thiago T Ambale-Venkatesh Bharath B Xie Eric E Ostovaneh Mohammad R MR Habibi Mohammadali M Bluemke David A DA Soliman Elsayed Z EZ Wu Colin O CO Heckbert Susan R SR Nazarian Saman S Lima João A C JAC

Radiology. Cardiothoracic imaging 20230713 4

<h4>Purpose</h4>To determine the prevalence and correlates of left atrial (LA) late gadolinium enhancement (LGE) at cardiac MRI and its association with atrial fibrillation (AF) in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA).<h4>Materials and methods</h4>In this secondary post hoc analysis of the MESA cohort (ClinicalTrials.gov no. NCT00005487), participants without AF underwent LGE cardiac MRI at the fifth examination (2010-2012). LA LGE burden was quantified ...[more]

PMID: 37693199

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Project description:Background Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). Purpose To investigate the prognostic value of a left atrioventricular coupling index (LACI) and average annualized change in LACI (hereafter, ΔLACI) measured by cardiac MRI to predict incident AF in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods In a secondary analysis of the prospective MESA, 1911 study participants without clinically recognized AF and cardiovascular disease at baseline had LACI assessed with cardiac MRI at baseline (examination 1, 2000-2002) and 10 years later (examination 5, 2010-2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average ΔLACI with incident AF. Results Among the 1911 participants (mean age, 59 years ± 9 [standard deviation]; 907 men), 87 incident AF events occurred over 3.9 years ± 0.9 after the second imaging (examination 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (hazard ratio, 1.69 [95% CI: 1.46, 1.96] and 1.71 [95% CI: 1.50, 1.94], respectively; both P < .001). Adjusted models for LACI and ΔLACI showed improvement in model discrimination compared with currently used AF risk score (Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score) model (area under receiver operating characteristic curve [AUC], 0.78 vs 0.74; and AUC, 0.80 vs 0.74, respectively; both P < .001); and to the final model including individual LA or LV parameters for predicting AF incidence (AUC, 0.78 vs 0.76; and AUC, 0.80 vs 0.78, respectively; both P < .001). Conclusion Atrioventricular coupling (left atrioventricular coupling index [LACI]) and coupling change (annual change in LACI) were strong predictors for atrial fibrillation (AF) in a multiethnic population. Both had incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination compared with the Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score and to individual left atrial or left ventricular parameters. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Leiner in this issue.

Project description:PurposeTo 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 methodsTwenty-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.ResultsMean 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).ConclusionThe 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.

Dataset Information

Association between Left Atrial Late Gadolinium Enhancement and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA).

Purpose

Materials and methods

Results

Conclusion

Publications

Association between Left Atrial Late Gadolinium Enhancement and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA).

Similar Datasets

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