title: The association of baseline left atrial structure and function measured with cardiac magnetic resonance and pulmonary vein isolation outcome in patients with drug-refractory atrial fibrillation.
abstract: Prognostic significance of left atrial (LA) function in patients with atrial fibrillation (AF) is poorly defined.
  
  
  
  To examine the association of LA function measured with cardiac magnetic resonance (CMR) feature-tracking and AF recurrence following catheter ablation.
  
  
  
  One hundred and twenty-one AF patients (72% paroxysmal, mean age 59 ± 10 years) were enrolled. Baseline LA function was measured by calculating passive, active, and total emptying fractions (LAEF) and analysis of global longitudinal strain and strain rates. Patients were followed up for recurrence of AF or atrial tachycardia (AT). Hazard ratios for recurrence were calculated using Cox proportional models adjusted for potential clinical confounders, type of AF, left ventricular ejection fraction, AF duration, LA volume, and late gadolinium enhancement (LGE).
  
  
  
  During a mean follow-up of 18 ± 9 months, 52 patients (43%) experienced recurrent AF/AT. Patients with recurrent AF/AT had higher baseline LA volume index and lower LA passive, and total LAEF (P < .05 for all). The baseline peak LA strain and strain rates in all phases of LA function were lower in the AF/AT recurrence group (P < .01 for all). In multivariable analysis total LAEF, peak LA strain, and systolic and late diastolic strain rates were associated with recurrence. Both peak LA strain and total LAEF improved prediction of recurrent AT/AF compared to the baseline clinical model, including LA LGE (C statistic 0.82 vs 0.77, P < .05 for both total LAEF and peak LA strain).
  
  
  
  LA reservoir function was independently associated with recurrent AF/AT after PVI and can additionally improve risk stratification in patients undergoing PVI.
authors.affiliation: Department of Cardiology, Baltimore, Maryland. Electronic address: mhabibi3@jhmi.edu.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Habibi
authors.affiliation: Department of Cardiology, Baltimore, Maryland.
authors.forename: Joao A C
authors.initials: JAC
authors.lastname: Lima
authors.affiliation: Department of Cardiology, Baltimore, Maryland.
authors.forename: Esra
authors.initials: E
authors.lastname: Gucuk Ipek
authors.affiliation: Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Stefan L
authors.initials: SL
authors.lastname: Zimmerman
authors.affiliation: Department of Biostatistics.
authors.forename: Vadim
authors.initials: V
authors.lastname: Zipunnikov
authors.affiliation: Department of Cardiology, Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Spragg
authors.affiliation: Department of Cardiology, Baltimore, Maryland.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ashikaga
authors.affiliation: Department of Cardiology, Baltimore, Maryland.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Department of Cardiology, Baltimore, Maryland.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.affiliation: Department of Cardiology, Baltimore, Maryland.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.affiliation: Department of Cardiology, Baltimore, Maryland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Department of Cardiology, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D004351:Drug Resistance; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006334:Heart Function Tests / Q000379:methods; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008396:Maryland; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Cardiac MRI; Left atrial fibrosis; Left atrial function; Pulmonary vein isolation