Atrial Fibrillation: Relationship between Left Atrial Pressure and Left Atrial Appendage Emptying Determined with Velocity-encoded Cardiac MR Imaging

Abstract

Purpose: To investigate the relationship between left atrial appendage (LAA) blood flow determined with cardiac magnetic resonance (MR) imaging and left atrial pressure (LAP) estimated from invasive catheter measurements in patients with atrial fibrillation (AF). Materials and Methods: This retrospective study was approved by the institutional review board, and patients provided written informed consent. Seventy-seven patients with AF (mean age, 57.8 years 6 9.8; range, 31-76 years) underwent cardiac MR imaging and catheter-based measurement of LAP, sequentially. Velocity-encoded (VENC) cardiac MR imaging was performed perpendicular to the ostium of the LAA. The maximum blood flux (in milliliters per second) from the LAA to the left atrium (LA) as determined with VENC MR imaging was defined as LAA emptying. Patients were classified into two groups: those with elevated LAP (peak LAP. 19 mm Hg) and those with nonelevated LAP (peak LAP,19 mm Hg). Receiver operating characteristic curves were used to determine the cut-off values of LAA emptying in the assessment of the LAP status. Results: LAA emptying showed a significantly inverse relationship (P < .01) with the peak LAP. Patients with elevated LAP showed significantly less LAA emptying than did patients with nonelevated LAP (mean, 39.3 mL/sec +/- 13.7 vs 61.2 mL/sec +/- 20.7, respectively; P < .01). In the assessment of elevated LAP with use of VENC MR imaging in normal sinus rhythm, the LAA emptying cut-off value of 47 mL/sec had a sensitivity of 75.0%, specificity of 87.5%, positive predictive value of 66.6%, and negative predictive value of 91.3%. At multivariate analysis, the odds ratio of low LAA emptying (< 47 mL/sec) was independently associated with elevated LAP. Conclusion: Evaluation of LAA emptying with use of VENC MR imaging is helpful for assessing the LAP status of patients with AF. (C) RSNA, 2017