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

Ciuffo, Luisa; Sharma, Ravi; Habibi, Mohammadali; Ambale Venkatesh, Bharath; Rosen, Boaz; Imai, Masamichi; Shea, Steven J. C.; McClelland, Robyn; Wu, Colin; Heckbert, Susan; Bluemke, David; Lima, Joao

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. 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.


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Journal of Cardiovascular Magnetic Resonance

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February 3, 2015