Assessing left atrial function in patients with atrial fibrillation and valvular heart disease using cardiovascular magnetic resonance imaging

Abstract

Background: Atrial fibrillation (AF) is common arrhythmia in valvular heart disease (VHD) and is associated with adverse outcomes. Hypothesis: To evaluate the left atrial (LA) function in patients with AF-VHD by cardiovascular magnetic resonance imaging feature tracking (CMR-FT) using LA strain (εs/εe/εa) and their corresponding strain rate (SRs/SRe/SRa). Methods: This was a retrospective cross-sectional inter-reader and intra-reader reproducibility conducted from July 1, 2020, to January 31, 2021. A total of 39 patients with AF-VHD (rheumatic heart valvular disease [RHVD] [n = 22], degenerative heart valvular disease [DHVD] [n = 17]) underwent MRI scans performed with drug-controlled heart rate before correcting the rhythm and valves through maze procedure. Fifteen participants with normal cardiac MRI were included as healthy control. εs/SRs, εe/SRe, and εa/SRa, corresponding to LA reservoir, conduit, and booster-pump function, were assessed using Feature Tracking software (CVI42 v5.12.1). Results: Compared with healthy controls, LA global strain parameters (εs/εe/εa/SRs/SRe/SRa) were significantly decreased (all p < 0.001), while LA size and volume were increased in AF-VHD group (all p < 0.001). In the subgroup, RHVD group showed lower LA total ejection fraction (LATEF) and strain data than DHVD group (12.6% ± 3.3% vs. 19.4 ± 8.6, p = 0.001). Decreased LATEF was significantly related to altered LA strain and strain rate, especially in εs, εe, and SRs (Pearson/Spearman r/ρ = 0.856/0.837/0.562, respectively; all p < 0.001). Interstudy and intrastudy reproducibility were consistent for LA volumetry and strain parameters (intraclass correlation coefficient: 0.88–0.99). Conclusions: CMR-FT can be used to assess the LA strain parameters, and identify LA dysfunction and deformation noninvasively, which could be a helpful functional imaging biomarker in the clinical treatment of AF-VHD.