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CMR assessment of left atrial quantitation in aortic stenosis: reproducibility and comparison of different techniques

Session Poster session 2

Speaker Aseel Alfuhied

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Dimensions, Volumes and Mass
  • Session type : Poster Session

Authors : A Alfuhied (Leicester,GB), S Elfawal (Leicester,GB), K Parke (Leicester,GB), J Wormleighton (Leicester,GB), G Mccann (Leicester,GB), A Singh (Leicester,GB)

Authors:
A Alfuhied1 , S Elfawal2 , K Parke3 , J Wormleighton3 , G Mccann3 , A Singh3 , 1University of Leicester, Cardiovascular Science - Leicester - United Kingdom of Great Britain & Northern Ireland , 2University Hospitals of Leicester NHS Trust, Radiology - Leicester - United Kingdom of Great Britain & Northern Ireland , 3NIHR Biomedical Research Unit in Cardiovascular Disease - Leicester - United Kingdom of Great Britain & Northern Ireland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii336

Background: Short axis (SAX) method is the gold standard for measuring left atrial (LA) volume, however, Biplane area length method (ALM) has been used widely in clinical practice. This is for practical reasons, since 4- and 2-chamber cines are routinely acquired. However, their test-retest reproducibility has not been well studied.

Methods: 11 patients with moderate-severe aortic stenosis (AS) had two CMR’s a week apart at 3T. LA minimum and maximum volumes and LA ejection fraction (EF) were quantified by SAX and ALM (including and excluding the LA appendage) by two observers. The inter-observer and test-retest reproducibility were assessed. 

Results: There was excellent correlation between volumes with and without LAA inclusion on ALM, with no difference in LAEF. There was good correlation in the volumes using ALM and SAX methods, with slightly higher volumes and lower LAEF using SAX (p<0.01 and p=0.03 respectively excluding LAA). The test-retest repeatability was excellent for SAX (CoV ~10%, ICC 0.96) and moderate for ALM (CoV 18-23% excluding LAA and 20-30% including LAA, ICC ~0.8 for volumes only).

Conclusion: SAX stack is the most reproducible method for assessing LA volumes and LAEF by CMR in AS patients. However, LA volumes correlate well with biplane method, but with poorer reproducibility for LAEF.

LA Volumes and EF measured by Biplane area-length method vs Short axis method
Parameter

ALM (Mean±SD)

SAX

(Mean±SD)

P-value(Biplane vs SAX)

Paired mean difference (SD)

Limits of agreement(upper, lower)

R (Pearson's correlation) P-value CoV

LAVmax _LAA (ml)

96.3±26.4 98.7±23.8 0.54 -2.40 (12.5) (22.1,-26.9) 0.88 <0.001 16.55

LAVmin _LAA (ml)

48.1±16.1 55.9±19.8 0.02 -7.79(8.97) (9.8,-25.4) 0.89 <0.001 17.24

LAEF_LAA(%)

50.3±5.6 44.1±8.3 0.02

6.26 (7.81)

(21.6,-9.1) 0.42 0.20 12.81

LAVmax(ml)

80.9±23.2 98.7±23.8 <0.001 -17.8 (9.98) (1.8,-37.4) 0.91 <0.001 11.11

LAVmin(ml)

41.1±13.7 55.9±19.8 <0.001 -14.8 (10.2) (5.11,-34.8) 0.88 <0.001 20.98
LAEF (%) 49.7±5.8 44.1±8.3 0.03 5.59 (7.19) (19.7,-8.5) 0.53 0.095 15.35
Biplane area-length method Including LAA vs Excluding LAA
Parameter

Including LAA (Mean±SD)

Excluding LAA (Mean±SD)

P-value(Including vs Excluding LAA)

Paired mean difference (SD)

Limits of agreement(upper, lower)

R (Pearson's Correlation) P-value CoV
LAVmax (ml) 96.3±26.4 80.9±22.1 <0.001 15.4 (5.6) (26.3,4.5) 0.99 <0.001 6.29

LAVmin (ml)

48.1±16.1 41.0±13.7 <0.001 7.04 (3.0) (12.9,1.14) 0.99 <0.001 6.75
LAEF (%) 50.3±5.6 49.7±5.8 0.31 0.67 (2.0) (4.67,-3.34) 0.94 <0.001 4.09
LAV max: Maximum left atrial volume, LAV min: Minimum left atrial volume, _LAA: Including LA appendage, LAEF: Left atrial ejection fraction, CoV: Coefficient of variation.

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