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The reproducibility of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study.
- Source :
-
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance [J Cardiovasc Magn Reson] 2018 Mar 19; Vol. 20 (1), pp. 21. Date of Electronic Publication: 2018 Mar 19. - Publication Year :
- 2018
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Abstract
- Background: Cardiovascular magnetic resonance (CMR) imaging has been used to visualise post-ablation atrial scar (PAAS), generally employing a three-dimensional (3D) late gadolinium enhancement (LGE) technique. However the reproducibility of PAAS imaging has not been determined. This cross-over study is the first to investigate the reproducibility of the technique, crucial for both future research design and clinical implementation.<br />Methods: Forty subjects undergoing first time ablation for atrial fibrillation (AF) had detailed CMR assessment of PAAS. Following baseline pre-ablation scan, two scans (separated by 48 h) were performed at three months post-ablation. Each scan session included 3D LGE acquisition at 10, 20 and 30 min post administration of gadolinium-based contrast agent (GBCA). Subjects were allocated at second scan post-ablation to identical imaging parameters ('Repro', n = 10), 3 T scanner ('3 T', n = 10), half-slice thickness ('Half-slice', n = 10) or half GBCA dose ('Half-gad', n = 10). PAAS was compared to baseline scar and then reproducibility was assessed for two measures of thresholded scar (% left atrial (LA) occupied by PAAS (%LA PAAS) and Pulmonary Vein Encirclement (PVE)), and then four measures of non-thresholded scar (point-by-point assessment of PAAS, four normalisation methods). Thresholded measures of PAAS were evaluated against procedural outcome (AF recurrence).<br />Results: A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. At 20 and 30 min, inter-scan reproducibility was good to excellent (coefficient of variation at 20 min and 30 min: %LA PAAS 0.41 and 0.20; PVE 0.13 and 0.04 respectively for 'Repro' group). Changes in imaging parameters, especially reduced GBCA dose, reduced inter-scan reproducibility, but for most measures remained good to excellent (ICC for %LA PAAS 0.454-0.825, PVE 0.618-0.809 at 30 min). For non-thresholded scar, highest reproducibility was observed using blood pool z-score normalisation technique: inter-scan ICC 0.759 (absolute agreement, 'Repro' group). There was no significant relationship between indices of PAAS and AF recurrence.<br />Conclusion: PAAS imaging is a reproducible finding. Imaging should be performed at least 20 min post-GBCA injection, and a blood pool z-score should be considered for normalisation of signal intensities. The clinical implications of these findings remain to be established in the absence of a simple correlation with arrhythmia outcome.<br />Trial Registration: United Kingdom National Research Ethics Service 08/H0802/68 - 30th September 2008.
- Subjects :
- Aged
Atrial Fibrillation diagnostic imaging
Atrial Fibrillation physiopathology
Cicatrix etiology
Cicatrix pathology
Cicatrix physiopathology
Cross-Over Studies
Female
Heart Atria pathology
Heart Atria physiopathology
Humans
Male
Middle Aged
Myocardium pathology
Predictive Value of Tests
Recurrence
Reproducibility of Results
Time Factors
Treatment Outcome
Atrial Fibrillation surgery
Catheter Ablation adverse effects
Cicatrix diagnostic imaging
Contrast Media administration & dosage
Heart Atria diagnostic imaging
Heart Atria surgery
Magnetic Resonance Imaging, Cine
Organometallic Compounds administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1532-429X
- Volume :
- 20
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
- Publication Type :
- Academic Journal
- Accession number :
- 29554919
- Full Text :
- https://doi.org/10.1186/s12968-018-0438-y