Left Atrial 4-Dimensional Flow Magnetic Resonance Imaging: Stasis and Velocity Mapping in Patients With Atrial Fibrillation.
Left Atrial 4-Dimensional Flow Magnetic Resonance Imaging: Stasis and Velocity Mapping in Patients With Atrial Fibrillation.
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DOI：
10.1097/rli.0000000000000219
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发表时间：
2016-03
影响因子：
6.7
通讯作者：
Goldberger JJ
中科院分区：
文献类型：
--
作者：
Markl M;Lee DC;Ng J;Carr M;Carr J;Goldberger JJ
采用左心房（LA）4D血流MRI推导心房颤动（AF）患者LA停滞、峰值速度和峰值速度时间（TTP）的解剖图，并确定LA血流与LA容积和患者特征之间的关系。在111名受试者中进行了4D flow MRI，用于时间分辨3D LA血流速度的体内评估：42名有AF病史和窦性心律（AF-窦性）的患者，39名持续性AF（AF-房颤）患者，10名年轻健康志愿者（HV）和20名年龄适当的对照（CTRL）。数据分析包括LA的3D分割和LA静态、峰值速度和TTP图的计算。通过计算LA中心区域和LA壁附近区域的平均淤滞、峰值速度和TPP来量化局部LA血流动力学。敏感性分析确定了整体LA停滞的阈值（<0.1m/s）和峰值流速（最高5%左心房速度），检测到房颤患者和对照组之间的整体左心房停滞的显著差异（HV=25± 5%，CTRL=29± 10%，AF-窦=41± 13%，AF-房颤=52±17%）和峰值速度（HV=0.43±0.02m/s，CTRL=0.37±0.04m/s，AF-窦=0.33±0.05m/s，AF-房颤=0.30±0.05m/s）。区域分析显示，与年龄相适应的对照组相比，AF患者的左心房中心和室壁的淤滞显著增加（差异29%-84%，p<0.006），AF-房颤与AF-窦性患者相比（差异22%-30%，p<0.004）。此外，与所有受试者组的LA中心相比，靠近LA壁的淤滞显著升高（p<0.001）。多重回归分析显示左心房血流受损（流速降低和淤滞增加）与年龄之间存在显著关系（R2 Adj =0.45-0.50，p<0.001）。|β| =0.27-0.50，p<0.002）和LA体积（|β| =0.26-0.50，p<0.003）。心房4D血流MRI检测了与AF、年龄和LA体积相关的整体和局部LA血流动力学变化。需要进行纵向研究，以测试左心房血流指标作为血栓栓塞事件潜在风险因素的诊断价值。
Left atrial (LA) 4D flow MRI was employed to derive anatomic maps of LA stasis, peak velocity, and time-to-peak velocity (TTP) in patients with atrial fibrillation (AF) and to identify relationships between LA flow with LA volume and patient characteristics. 4D flow MRI for the in-vivo assessment of time-resolved 3D LA blood flow velocities was performed in 111 subjects: 42 patients with a history of AF and in sinus rhythm (AF-sinus), 39 patients with persistent AF (AF-afib), 10 young healthy volunteers (HV), and 20 age appropriate controls (CTRL). Data analysis included the 3D segmentation of the LA and the calculation of LA stasis, peak velocity and TTP maps. Regional LA flow dynamics were quantified by calculating mean stasis, peak velocity and TPP in the LA center region and the region adjacent to the LA wall. A sensitivity analysis identified thresholds for global LA stasis (<0.1m/s) and peak velocity (top 5% LA velocities) which detected significant differences between AF patients and controls for global LA stasis (HV=25±5%, CTRL=29±10%, AF-sinus=41±13%, AF-afib=52±17%) and peak velocity (HV=0.43±0.02m/s, CTRL=0.37±0.04m/s, AF-sinus=0.33±0.05m/s, AF-afib=0.30±0.05m/s). Regional analysis revealed significantly increased stasis at both LA center and wall for AF patients compared to age appropriate controls (29%-84% difference, p<0.006) and for AF-afib vs. AF-sinus patients (22%-30% difference, p<0.004). In addition, stasis close to the LA wall was significantly elevated (p<0.001) compared to the LA center for all subject groups. Multiple regressions revealed significant (R2Adj=0.45-0.50, p<0.001) relationships between impaired global LA flow (reduced velocity and increased stasis) with age (|β|=0.27-0.50, p<0.002) and LA volume (|β|=0.26-0.50, p<0.003). Atrial 4D flow MRI detected changes in global and regional LA flow dynamics associated with AF, age and LA volume. Longitudinal studies are needed to test the diagnostic value of LA flow metrics as potential risk factors for thromboembolic events.