Skip to main content
SpringerLink
Log in

Predictive value of a comprehensive atrial assessment with cardiac magnetic resonance in non-ischemic cardiomyopathy: keep it simple

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Cardiac magnetic resonance (CMR) can provide a multi-parametric evaluation of left atrial (LA) size and function. A complete CMR-based LA assessment might improve the risk stratification of patients with non-ischemic dilated cardiomyopathy (DCM). We performed a comprehensive CMR-based evaluation of LA size and function, in order to assess the prognostic impact of specific LA parameters in DCM. Secondary analysis of a prospective registry (UHSM-CMR study, NCT02326324) including 648 consecutive patients with DCM and CMR evaluation of LA area and LA length. Of these, 456 had complete LA assessment covering reservoir, conduit and booster pump function and including LA reservoir strain evaluated with feature tracking. The heart failure (HF) endpoint included HF hospitalizations, HF death and heart transplant. The arrhythmic endpoint included ventricular arrhythmias (VA) (sustained or treated by implantable defibrillator) and sudden death (SD). At median follow-up of 23 months, 34 patients reached the HF endpoint; in a multivariable model including NYHA class and LVEF, LA length had incremental predictive value. LA length ≥ 69 mm was the best cut-off to predict HF events (adjusted HR 2.3, p = 0.03). Among the 456 patients with comprehensive LA assessment, only LA length was independently associated with the HF endpoint after adjusting for LVEF and NYHA class. By contrast, no LA parameter independently predicted the arrhythmic risk. In DCM patients, LA length is an independent predictor of HF events, showing stronger association than other more complex parameters of LA function. No atrial parameter predicts the risk of VA and SD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data Availability

The dataset is contained within the UHSM-redCAP database as part of the UHSM-CMR study. The datasets used and/or analysed during the current study may be available from the corresponding author on reasonable request.

Abbreviations

AF:

atrial fibrillation

AIC:

Akaike information criterion

CMR(i):

cardiac magnetic resonance (imaging)

DCM:

dilated cardiomyopathy

ECV:

extracellular volume

EF:

ejection fraction

EPR:

electronic patient records

FT:

feature tracking

HF:

heart failure

HFH:

heart failure hospitalisation

ICD:

implantable cardioverter defibrillator

LA:

left atrium

LGE:

late gadolinium enhancement

LV:

left ventricle

ROC:

receiver operator curves

SAE:

significant arrhythmic event

SD:

sudden death

SSFP:

steady state free precession

VA:

ventricular arrhythmia

References

  1. Triposkiadis F et al (1994) Left atrial myopathy in idiopathic dilated cardiomyopathy. Am Heart J 128(2):308–315

    Article  CAS  PubMed  Google Scholar 

  2. Rossi A et al (2009) Independent relationship of left atrial size and mortality in patients with Heart Failure: an individual patient meta-analysis of longitudinal data (MeRGE Heart Failure). Eur J Heart Fail 11(10):929–936

    Article  PubMed  Google Scholar 

  3. Rossi A et al (2002) Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy. J Am Coll Cardiol 40(8):1425

    Article  PubMed  Google Scholar 

  4. Modena MG et al (1997) Left atrial size is the major predictor of cardiac death and overall clinical outcome in patients with dilated cardiomyopathy: a long-term follow-up study. Clin Cardiol 20(6):553–560

    Article  CAS  PubMed  Google Scholar 

  5. Negishi K et al (2016) Left atrial booster pump function is an Independent predictor of subsequent life-threatening ventricular arrhythmias in non-ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging 17(10):1153–1160

    Article  PubMed  Google Scholar 

  6. Modin D et al (2019) Prognostic Value of Left Atrial Functional measures in Heart Failure with reduced ejection fraction. J Card Fail 25(2):87–96

    Article  PubMed  Google Scholar 

  7. Kowallick JT et al (2014) Quantification of left atrial strain and strain rate using Cardiovascular magnetic resonance myocardial feature tracking: a feasibility study. J Cardiovasc Magn Reson 16:60

    Article  PubMed  PubMed Central  Google Scholar 

  8. Truong VT et al (2020) Normal left atrial strain and strain rate using cardiac magnetic resonance feature tracking in healthy volunteers. Eur Heart J Cardiovasc Imaging 21(4):446–453

    MathSciNet  PubMed  Google Scholar 

  9. Li Y et al (2022) Left atrial function predicts Outcome in Dilated Cardiomyopathy: fast Long-Axis strain analysis derived from MRI. Radiology 302(1):72–81

    Article  PubMed  Google Scholar 

  10. Raafs AG et al (2022) Left atrial strain has Superior Prognostic Value to ventricular function and delayed-enhancement in dilated cardiomyopathy. JACC Cardiovasc Imaging 15(6):1015–1026

    Article  PubMed  Google Scholar 

  11. Maceira AM et al (2006) Normalized left ventricular systolic and diastolic function by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 8(3):417–426

    Article  CAS  PubMed  Google Scholar 

  12. Di Marco A et al (2021) Improved risk stratification for ventricular arrhythmias and sudden death in patients with nonischemic dilated cardiomyopathy. J Am Coll Cardiol 77(23):2890–2905

    Article  PubMed  Google Scholar 

  13. Kramer CM et al (2013) Standardized cardiovascular magnetic resonance (CMR) protocols 2013 update. J Cardiovasc Magn Reson 15:91

    Article  PubMed  PubMed Central  Google Scholar 

  14. Miller CA et al (2013) Quantification of left ventricular indices from SSFP cine imaging: impact of real-world variability in analysis methodology and utility of geometric modeling. J Magn Reson Imaging 37(5):1213–1222

    Article  PubMed  Google Scholar 

  15. Hudsmith LE et al (2005) Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. J Cardiovasc Magn Reson 7(5):775–782

    Article  PubMed  Google Scholar 

  16. H., A., A new look at the statistical model identification. IEEE Trans Autom Control, 1974(6): p. 716–723

  17. Urbich M et al (2020) A systematic review of medical costs Associated with Heart Failure in the USA (2014–2020). PharmacoEconomics 38(11):1219–1236

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jong P et al (2002) Prognosis and determinants of survival in patients newly hospitalized for Heart Failure: a population-based study. Arch Intern Med 162(15):1689–1694

    Article  PubMed  Google Scholar 

  19. Gulati A et al (2013) Clinical utility and prognostic value of left atrial volume assessment by cardiovascular magnetic resonance in non-ischaemic dilated cardiomyopathy. Eur J Heart Fail 15(6):660–670

    Article  CAS  PubMed  Google Scholar 

  20. Yazaki M et al (2021) Clinical significance of left atrial geometry in dilated cardiomyopathy patients: a cardiovascular magnetic resonance study. Clin Cardiol 44(2):222–229

    Article  PubMed  Google Scholar 

  21. Álvarez-García J et al (2015) A simple validated method for predicting the risk of hospitalization for worsening of Heart Failure in ambulatory patients: the Redin-SCORE. Eur J Heart Fail 17(8):818–827

    Article  PubMed  Google Scholar 

  22. Habibi M et al (2014) Association of CMR-measured LA function with Heart Failure development: results from the MESA study. JACC Cardiovasc Imaging 7(6):570–579

    Article  PubMed  PubMed Central  Google Scholar 

  23. Chirinos JA et al (2018) Left atrial phasic function by Cardiac magnetic resonance feature tracking is a strong predictor of Incident Cardiovascular events. Circ Cardiovasc Imaging 11(12):e007512

    Article  PubMed  PubMed Central  Google Scholar 

  24. Nistri S et al (2006) Prognostic significance of left atrial size in patients with hypertrophic cardiomyopathy (from the Italian Registry for hypertrophic cardiomyopathy). Am J Cardiol 98(7):960–965

    Article  PubMed  Google Scholar 

  25. Spirito P et al (2009) Syncope and risk of sudden death in hypertrophic cardiomyopathy. Circulation 119(13):1703–1710

    Article  PubMed  Google Scholar 

  26. O’Mahony C et al (2014) A novel clinical risk prediction model for Sudden Cardiac Death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J 35(30):2010–2020

    Article  PubMed  Google Scholar 

  27. Di Marco A et al (2017) Late Gadolinium Enhancement and the risk for ventricular arrhythmias or sudden death in dilated cardiomyopathy: systematic review and Meta-analysis. JACC Heart Fail 5(1):28–38

    Article  PubMed  Google Scholar 

  28. Desai AS et al (2004) Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta-analysis of randomized controlled trials. JAMA 292(23):2874–2879

    Article  CAS  PubMed  Google Scholar 

  29. Beggs SAS et al (2018) Non-ischaemic cardiomyopathy, sudden death and implantable defibrillators: a review and meta-analysis. Heart 104(2):144–150

    Article  CAS  PubMed  Google Scholar 

  30. Puntmann VO et al (2016) T1-Mapping and outcome in nonischemic cardiomyopathy: all-cause mortality and Heart Failure. JACC Cardiovasc Imaging 9(1):40–50

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Dr Brown was in receipt of a joint Alliance Medical + UHSM Fellowship Salary support grant. Drs Miller and Schmitt received a restricted grant by Guerbet in support of the UHSM CMR study (NCT02326324).

Author information

Author notes

  1. Pamela Frances Brown and Andrea Di Marco contributed equally to this work and share the role of corresponding authors.

Authors and Affiliations

  1. Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK

    Pamela Frances Brown, Anna Reid, Joshua Bradley, Christopher Miller & Matthias Schmitt

  2. Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK

    Pamela Frances Brown, Andrea Di Marco, Zoi Tsoumani, Anna Reid, Joshua Bradley, Gaetano Nucifora, Christopher Miller & Matthias Schmitt

  3. Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    Andrea Di Marco & Ignasi Anguera

  4. Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK

    Christopher Miller

  5. Bio Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain

    Andrea Di Marco & Ignasi Anguera

  6. Cardiology department, Bellvitge University Hospital, carrer feixa llarga sin número, Hospitalet de Llobregat, Barcelona, 08907, Spain

    Andrea Di Marco

Authors
  1. Pamela Frances Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Di Marco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zoi Tsoumani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Reid
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joshua Bradley
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gaetano Nucifora
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ignasi Anguera
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christopher Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Matthias Schmitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PB/AdiM/MS conceived, wrote and revised the manuscript. PB/ZT/JB/AR contributed to data collection. AdiM conducted statistical analysis. AdiM/MS/CM/GN supervised the project. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Pamela Frances Brown or Andrea Di Marco.

Ethics declarations

Ethics approval and consent to participate

Participants were recruited from the UHSM-CMR Study, National Clinical Trials number 02326324, and received appropriate ethical approval (IRAS id is: 159694 and REC reference: 14/NW/1165). All patients gave written, informed consent for participation.

Consent for publication

All patients gave written, informed consent for publication.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brown, P.F., Di Marco, A., Tsoumani, Z. et al. Predictive value of a comprehensive atrial assessment with cardiac magnetic resonance in non-ischemic cardiomyopathy: keep it simple. Int J Cardiovasc Imaging 40, 557–567 (2024). https://doi.org/10.1007/s10554-023-03024-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-023-03024-4

Keywords

Search

Navigation