Left atrial volume assessment in atrial fibrillation using multimodality imaging: a comparison of echocardiography, invasive three-dimensional CARTO and cardiac magnetic resonance imaging Journal Article


Authors: Rabbat, M. G.; Wilber, D; Thomas, K.; Malick, O.; Bashir, A.; Agrawal, A.; Biswas, S.; Sanagala, T; Syed, M. A.
Article Title: Left atrial volume assessment in atrial fibrillation using multimodality imaging: a comparison of echocardiography, invasive three-dimensional CARTO and cardiac magnetic resonance imaging
Abstract: Left atrial size in atrial fibrillation is a strong predictor of successful ablation and cardiovascular events. Cardiac magnetic resonance multislice method (CMR-MSM) is the current gold standard for left atrial volume (LAV) assessment but is time consuming. We investigated whether LAV with more rapid area-length method by echocardiography (Echo-AL) or cardiac magnetic resonance (CMR-AL) and invasive measurement by 3D-CARTO mapping during ablation correlate with the CMR-MSM. We studied 250 consecutive patients prior to atrial fibrillation ablation. CMR images were acquired on 3T scanner to measure LAV by MSM and biplane area-length method. Standard echocardiography views were used to calculate LAV by biplane area-length method. LAV during ablation was measured by 3D-CARTO mapping. LAV was compared using intra-class correlation (ICC), Pearson's correlation and Bland-Altman plots. CMR-MSM was used as the reference standard. Mean LAV using CMR-MSM was 112.7 +/- 36.7 ml. CMR-AL method overestimated LAV by 13.3 +/- 21.8 ml (11.2 %, p 0.005) whereas 3D-CARTO and Echo-AL underestimated LAV by 8.3 +/- 22.6 and 24.0 +/- 27.6 ml respectively (8.7 % and 20.0 % respectively, p 0.005). There was no significant difference between paroxysmal and persistent atrial fibrillation. CMR-AL and 3D-CARTO correlated and agreed well with CMR-MSM (r = 0.87 and 0.74, ICC = 0.80 and 0.77 respectively). However, Echo-AL had poor correlation and agreement with CMR-MSM (r = 0.66 and ICC = 0.48). Bland-Altman plots confirmed these findings. CMR-AL method may be used as an alternative to CMR-MSM, as it is non-invasive, rapid, and correlates well with CMR-MSM. LAV by different modalities should not be used interchangeably.
Journal Title: The international journal of cardiovascular imaging
Volume: 31
Issue: 15
ISSN: 1875-8312; 1569-5794
Publisher: Unknown  
Date Published: 2015
Start Page: 1011
End Page: 1018
Language: ENG
DOI/URL:
Notes: LR: 20150313; JID: 100969716; 2014/12/22 [received]; 2015/03/09 [accepted]; 2015/03/12 [aheadofprint]; aheadofprint