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Reproducibility of left atrial function using cardiac magnetic resonance imaging

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journal contribution
posted on 11.12.2020, 09:45 by Aseel Alfuhied, Benjamin A Marrow, Sara Elfawal, Gaurav S Gulsin, Mathew P Graham-Brown, Christopher D Steadman, Prathap Kanagala, Gerry P McCann, Anvesha Singh
Objectives
To determine the test-retest reproducibility and observer variability of CMR-derived LA function, using (i) LA strain (LAS) and strain rate (LASR), and (ii) LA volumes (LAV) and emptying fraction (LAEF).

Methods
Sixty participants with and without cardiovascular disease (aortic stenosis (AS) (n = 16), type 2 diabetes (T2D) (n = 28), end-stage renal disease on haemodialysis (n = 10) and healthy volunteers (n = 6)) underwent two separate CMR scans 7–14 days apart. LAS and LASR, corresponding to LA reservoir, conduit and contractile booster-pump function, were assessed using Feature Tracking software (QStrain v2.0). LAEF was calculated using the biplane area length method (QMass v8.1). Both were assessed using 4- and 2-chamber long-axis standard steady-state free precession cine images, and average values were calculated. Intra- and inter-observer variabilities were assessed in 10 randomly selected participants.

Results
The test-retest reproducibility was moderate to poor for all strain and strain rate parameters. Overall, strain and strain rate corresponding to reservoir phase (LAS_r, LASR_r) were the most reproducible, yielding the smallest coefficient of variance (CoV) (29.9% for LAS_r, 28.9% for LASR_r). The test-retest reproducibility for LAVs and LAEF was good: LAVmax CoV = 19.6% ICC = 0.89, LAVmin CoV = 27.0% ICC = 0.89 and total LAEF CoV = 15.6% ICC = 0.78. The inter- and intra-observer variabilities were good for all parameters except for conduit function.

Conclusion
The test-retest reproducibility of LA strain and strain rate assessment by CMR utilising Feature Tracking is moderate to poor across disease states, whereas LA volume and emptying fraction are more reproducible on CMR. Further improvements in LA strain quantification are needed before widespread clinical application.

Funding

This study has received funding by an NIHR Career Development Fellowship (Gerald P McCann, NIHR-CDF 2014-07-045), an NIHR grant (Gerald P McCann, PDF 2011-04-51), Clinician Scientist Award (Dr James Burton, CS-2013-13-014) supported by the NIHR, a Clinical Research Training Fellowship (Gaurav S Gulsin, FS/16/47/32190) supported by the BHF, and a BHF grant (PG/07/068/2334).

History

Citation

Eur Radiol (2020). https://doi.org/10.1007/s00330-020-07399-z

Author affiliation

Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

EUROPEAN RADIOLOGY

Pagination

(10)

Publisher

Springer

issn

0938-7994

eissn

1432-1084

Acceptance date

08/10/2020

Copyright date

2020

Available date

30/10/2020

Spatial coverage

Germany

Language

English