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Early detection of left atrial dysfunction assessed by CMR feature tracking in hypertensive patients

  • Lu Li
  • Xiuyu Chen
  • Gang Yin
  • Weipeng Yan
  • Chen Cui
  • Huaibin Cheng
  • Minjie Lu
  • Shihua ZhaoEmail author
Cardiac
  • 3 Downloads

Abstract

Objectives

To evaluate whether early left atrial (LA) dysfunction in hypertension (HTN), with or without left ventricular hypertrophy (LVH), can be detected by cardiovascular magnetic resonance feature tracking (CMR-FT).

Methods

Seventy-three HTN patients and 29 healthy controls were retrospectively recruited. HTN patients were divided into the LVH (n = 29) and non-LVH group (n = 44). LA performance was analysed using CMR-FT in 2- and 4-chamber cine images, including LA reservoir function (total ejection fraction [EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive EF, passive strain [εe], peak early negative strain rate [SRe]) and booster pump function (booster EF, active strain [εa], late peak negative strain rate [SRa]). One-way analysis of variance with post hoc LSD tests, Spearman analysis, receiver operating characteristic curve and intra-class correlation coefficient analysis were applied for statistical analyses.

Results

Compared with healthy controls, LA reservoir (LA total EF, εs, SRs) and conduit function (LA passive EF, εe, SRe) were significantly impaired in HTN patients with or without LVH, and these parameters significantly correlated with mitral E/A < 1 (all p < 0.05). However, LA booster pump function was relatively preserved in non-LVH patients, representing an intermediate stage between the LVH group and controls. Among LA deformation parameters, εe showed the highest diagnostic value for differentiation of HTN patients with healthy controls (AUC, 0.82; sensitivity, 80.82%; specificity, 72.41%). Observer reproducibility was good–excellent (ICC, 0.83–0.97) for all CMR-FT derived parameters.

Conclusions

CMR-FT is a promising tool for quantification of LA function. LA reservoir and conduit dysfunction might be detected early by CMR-FT in HTN patients before the presence of LVH.

Key Points

• CMR-FT is a promising tool in quantifying LA function, including deformation and volumetric parameters.

• LA reservoir and conduit dysfunction might be detected early by CMR-FT in HTN patients with or without LVH.

• The LA booster pump function was relatively preserved in non-LVH patients.

Keywords

Hypertension Magnetic resonance imaging Atrial function 

Abbreviations

b-SSFP

Balanced steady-state free precession

BSA

Body surface area

CMR

Cardiovascular magnetic resonance

CMR-FT

CMR feature tracking

DBP

Diastolic blood pressure

EDV

End-diastolic volume

EF

Ejection fraction

ESV

End-systolic volume

HF

Heart failure

HTN

Hypertension

LA

Left atrial

LA Vmax

Maximal LA volume

LA Vmin

Minimal LA volume

LA Vpac

Pre-atrial contractile LA volume

LV

Left ventricular

LVEDD

Left ventricular end-diastolic diameter

LVEF

Left ventricle ejection fraction

LVH

Left ventricular hypertrophy

LVM

Left ventricle mass

MWT

Maximal wall thickness

ROC

Receiver operating characteristic

SBP

Systolic blood pressure

SR

Strain rate

STE

Speckle tracking imaging

Notes

Acknowledgements

This study was made possible by the wonderful work of colleagues in department of Magnetic Resonance Imaging, Fuwai hospital, Beijing, China.

Funding

This study is supported by the National Natural Science Foundation of China (Grant No.81701659 and Grant No. 81620108015) and Capital Characteristic and Clinical Application Research Fund from the Beijing Municipal Commission of Science and Technology (Z161100000516110).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Shihua Zhao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Lu Li
    • 1
  • Xiuyu Chen
    • 1
  • Gang Yin
    • 1
  • Weipeng Yan
    • 1
  • Chen Cui
    • 1
  • Huaibin Cheng
    • 2
  • Minjie Lu
    • 1
  • Shihua Zhao
    • 1
    Email author
  1. 1.Department of CMRState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Department of Function Test CenterState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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