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. 2023 Sep;39(9):1753-1763.
doi: 10.1007/s10554-023-02866-2. Epub 2023 May 31.

Left atrial sphericity in relation to atrial strain and strain rate in atrial fibrillation patients

Luuk H G A Hopman  1 , Pranav Bhagirath  1 , Mark J Mulder  1 , Ahmet Demirkiran  1 , Sulayman El Mathari  2 , Anja M van der Laan  1 , Albert C van Rossum  1 , Michiel J B Kemme  1 , Cornelis P Allaart  1 , Marco J W Götte  3   4
Affiliations

Left atrial sphericity in relation to atrial strain and strain rate in atrial fibrillation patients

Luuk H G A Hopman et al. Int J Cardiovasc Imaging. 2023 Sep.

Abstract

Purpose: Left atrial (LA) sphericity is a novel, geometry-based parameter that has been used to visualize and quantify LA geometrical remodeling in patients with atrial fibrillation (AF). This study examined the association between LA sphericity, and LA longitudinal strain and strain rate measured by feature-tracking in AF patients.

Methods: 128 AF patients who underwent cardiovascular magnetic resonance (CMR) imaging in sinus rhythm prior to their pulmonary vein isolation (PVI) procedure were retrospectively analyzed. LA sphericity was calculated by segmenting the LA (excluding the pulmonary veins and the LA appendage) on a 3D contrast enhanced MR angiogram and comparing the resulting shape with a perfect sphere. LA global reservoir strain, conduit strain, contractile strain and corresponding strain rates were derived from cine images using feature-tracking. For statistical analysis, Pearson correlations, multivariable logistic regression analysis, and Student t-tests were used.

Results: Patients with a spherical LA (dichotomized by the median value) had a lower reservoir strain and conduit strain compared to patients with a non-spherical LA (-15.4 ± 4.2% vs. -17.1 ± 3.5%, P = 0.02 and - 8.2 ± 3.0% vs. -9.5 ± 2.6%, P = 0.01, respectively). LA strain rate during early ventricular diastole was also different between both groups (-0.7 ± 0.3s- 1 vs. -0.9 ± 0.3s- 1, P = 0.001). In contrast, no difference was found for LA contractile strain (-7.2 ± 2.6% vs. -7.6 ± 2.2%, P = 0.30).

Conclusions: LA passive strain is significantly impaired in AF patients with a spherical LA, though this relation was not independent from LA volume.

Keywords: Atrial fibrillation; Atrial remodeling; Atrial sphericity; Atrial strain; Cardiac MRI.

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Conflict of interest statement

Authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Illustration explaining CMR feature tracking derived phasic strain and strain rate curves (A) Illustration of a LA feature tracking longitudinal strain graph demonstrating the different phases of LA function. (B) Illustration of a LA feature tracking longitudinal strain rate graph. Feature tracking strain requires a left atrial endocardial and epicardial contour in the end systolic phase in the 2-chamber (C) and 4-chamber (D) cine images. An advanced post-processing technique tracks the LA wall over time
Fig. 2
Fig. 2
Illustration explaining the LA sphericity calculation A 3D reconstruction of the LA can be made using dedicated segmentation software. Thereafter, the pulmonary veins and LA appendage are excluded at their ostia, defined as the site of reflection of these structures with the LA wall. CEMRG software was used to automatically calculate LA sphericity. This software evaluates the variation between the LA and a sphere that best fits the LA shape. In short, the center of mass of the LA was determined. Hereafter, the average radius between all points of the LA wall and the center of mass was calculated. The average radius (AR) represents the radius of the sphere that best fits the LA. The AR standard deviation (SD) and AR of the distances between all points of the LA wall and the center of mass are used to calculate the LA sphericity with the formula [1 – (SD/AR) x 100%]
Fig. 3
Fig. 3
LA strain parameters in patients with a non-spherical and spherical LA geometry Difference in A) LA reservoir strain, B) LA conduit strain, and C) LA contractile strain between patients with a non-spherical and spherical LA geometry. Panel D, E and F demonstrate differences in LA strain rate between patients with a non-spherical and spherical LA geometry
Fig. 4
Fig. 4
LA strain in an AF patient with a non-spherical and spherical LA geometry Illustrative example of a patient with a non-spherical LA (A, B) and spherical LA (E,F), and the corresponding LA longitudinal strain curves and strain rate curves (C,D,G,H).
Fig. 5
Fig. 5
LA pressure – LA strain relation in patients with a non-spherical and spherical LA Correlation between LA pressure and LA reservoir strain in patients with a non-spherical LA (A) and patients with a spherical LA (B). Correlation between LA pressure and LA conduit strain in patients with a non-spherical LA (C) and patients with a spherical LA (D). Correlation between LA pressure and LA contractile strain in patients with a non-spherical LA (E) and patients with a spherical LA (F). mmHg; millimeter of mercury
See this image and copyright information in PMC

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