Age, Atrial Fibrillation, and Structural Heart Disease Are the Main Determinants of Left Atrial Fibrosis Detected by Delayed-Enhanced Magnetic Resonance Imaging in a General Cardiology Population

• Published in: Journal of cardiovascular electrophysiology Vol. 26; no. 5; pp. 484 - 492
• Main Authors: COCHET, HUBERT, MOURIES, AMAURY, NIVET, HUBERT, SACHER, FREDERIC, DERVAL, NICOLAS, DENIS, ARNAUD, MERLE, MATHILDE, RELAN, JATIN, HOCINI, MÉLÈZE, HAÏSSAGUERRE, MICHEL, LAURENT, FRANÇOIS, MONTAUDON, MICHEL, JAÏS, PIERRE
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-05-2015; Wiley Subscription Services, Inc
• Subjects: Adult; Age Factors; atrial fibrillation; Atrial Fibrillation - epidemiology; Atrial Fibrillation - pathology; atrial remodeling; Female; Fibrosis; France - epidemiology; heart; Heart Atria - pathology; Heart Diseases - epidemiology; Heart Diseases - pathology; Humans; Image Interpretation, Computer-Assisted - methods; magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Middle Aged; Predictive Value of Tests; Prevalence; Prospective Studies; Reproducibility of Results; Risk Factors; France; atrial remodeling; atrial fibrillation; magnetic resonance imaging; fibrosis; heart
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.12651

Atrial Fibrosis on MRI in Patients
Introduction
We studied the extent and distribution of left atrial (LA) fibrosis on delayed‐enhanced (DE) MRI in a general cardiology population.
Methods and Results
One hundred ninety consecutive patients referred for cardiac MRI underwent DE imaging using a free breathing method. The population comprised 60 AF patients and 130 patients without AF, including 75 with structural heart disease (SHD). DE was quantified using histogram thresholding, expressed in % of the wall. Regression analysis was performed to identify predictors of DE. Additionally, DE was registered on a template to study its distribution in subpopulations. In the total population, age, AF, and SHD were independently associated with DE. DE was increasingly observed from 11.1 ± 4.7% in patients with no SHD nor AF, 18.8 ± 7.8% in SHD and no AF history, 22.9 ± 7.8% in paroxysmal AF, to 27.8 ± 7.7% in persistent AF. Among non‐AF patients, age and SHD were independently associated with DE. Among AF patients, female gender and AF persistence were independently associated with DE. DE was variably distributed but more frequently detected in the posterior wall.
Conclusion
Age, history of AF, and SHD are the most powerful predictors of atrial fibrosis, as detected by MRI, in a general cardiology population. Atrial fibrosis predominates in the posterior LA wall.