Beyer Christoph, Tokarska Lyudmyla, Stühlinger Markus, Feuchtner Gudrun, Hintringer Florian, Honold Sarah, Fiedler Lukas, Schönbauer Marie-Sophie, Schönbauer Robert, Plank Fabian
Department of Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria.
Department of Internal Medicine II, Landesklinicum Wiener Neustadt Hospital, Wiener Neustadt, Austria.
JACC Cardiovasc Imaging. 2021 Nov;14(11):2199-2208. doi: 10.1016/j.jcmg.2021.04.027. Epub 2021 Jun 16.
This study sought to evaluate preablation computed tomography angiography (CTA) for atrial and epicardial features to predict atrial fibrillation (AF) recurrence after ablation.
Structural atrial remodeling is a process associated with occurrence or persistence of AF. Different anatomical imaging features have been proposed to influence atrial remodeling both negatively and positively as substrate for AF.
Patients with nonvalvular AF underwent cardiac CTA before pulmonary vein isolation at 2 high-volume centers. Left atrial (LA) and right atrial volumes, LA wall thickness (LAWT), and epicardial adipose tissue volume and attenuation were evaluated. Additional subanalyses of electroanatomical maps were made. Follow-up was performed for at least 12 months, including subanalysis of repeated cardiac CTA studies. Interrater variability was assessed.
Of 732 patients, 270 (36.9%) had AF recurrence after a mean of 7 months. CT analysis revealed larger indexed LA volume (47.3 mL/m vs 43.6 mL/m; P = 0.0001) and higher mean anterior (1.91 mm vs 1.65 mm; P < 0.0001) and posterior (1.61 mm vs 1.39 mm; P = 0.001) LAWT in patients with AF recurrence. Epicardial adipose tissue volume in patients with AF recurrence was higher (144.5 mm³ vs 128.5 mm³; P < 0.0001) and further progressed significantly in a subset of 85 patients after 2 years (+11.8 mm vs -3.5 mm; P = 0.041). Attenuation levels were lower, indicating a higher lipid component associated with AF recurrence (-69.1 HU vs -67.5 HU; P = 0.001). A total of 103 atrial voltage maps were highly predictive of AF recurrence and showed good discriminatory power for patients with low voltage >50% and LAWT (1.55 ± 0.5 mm vs 1.81 ± 0.6 mm; P = 0.032). Net reclassification improvement (NRI) showed a significant incremental benefit (NRI = 0.279; P < 0.0001) when adding LAWT to established risk models.
Atrial wall thickness, epicardial fat volume, and attenuation are associated with AF recurrence in patients undergoing ablation therapy.
本研究旨在评估消融术前计算机断层扫描血管造影（CTA）的心房和心外膜特征，以预测消融术后房颤（AF）复发情况。
心房结构重塑是一个与房颤发生或持续相关的过程。不同的解剖成像特征被认为对心房重塑有正负两方面的影响，可作为房颤的基质。
在2个大容量中心，非瓣膜性房颤患者在肺静脉隔离术前接受心脏CTA检查。评估左心房（LA）和右心房容积、LA壁厚度（LAWT）以及心外膜脂肪组织容积和衰减情况。对电解剖图进行了额外的亚组分析。随访至少12个月，包括对重复心脏CTA研究的亚组分析。评估了观察者间的变异性。
732例患者中，270例（36.9%）在平均7个月后出现房颤复发。CT分析显示，房颤复发患者的LA指数容积更大（47.3 mL/m vs 43.6 mL/m；P = 0.0001），LA前壁平均厚度（1.91 mm vs 1.65 mm；P < 0.0001）和后壁平均厚度（1.61 mm vs 1.39 mm；P = 0.001）更高。房颤复发患者的心外膜脂肪组织容积更高（144.5 mm³ vs 128.5 mm³；P < 0.0001），在85例患者的亚组中，2年后进一步显著增加（+11.8 mm vs -3.5 mm；P = 0.041）。衰减水平更低，表明与房颤复发相关的脂质成分更高（-69.1 HU vs -67.5 HU；P = 0.001）。总共103份心房电压图对房颤复发具有高度预测性，对低电压>50%和LAWT的患者具有良好的鉴别能力（1.55±0.5 mm vs 1.81±0.6 mm；P = 0.032）。当将LAWT添加到已建立的风险模型中时，净重新分类改善（NRI）显示出显著的增量效益（NRI = 0.279；P < 0.0001）。
心房壁厚度、心外膜脂肪容积和衰减与接受消融治疗患者的房颤复发相关。
