Lee Angela W C, Sillett Charles, Solis-Lemus José Alonso, Kessler Iglesias Cassia, Hopman Luuk H G A, Hua Alina, Wheen Peter, Qayyum Abdul, Strocchi Marina, Roney Caroline, Booth Thomas, Ismail Tevfik F, Chubb Henry, Ennis Daniel B, Jabbour Andrew, Fatkin Diane, Götte Marco J W, Niederer Steven A
School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK.
National Heart and Lung Institute, Imperial Centre for Translational and Experimental Medicine, Imperial College London, 72 Du Cane Rd, London W12 0NN, UK.
Eur Heart J Imaging Methods Pract. 2025 May 28;3(2):qyaf068. doi: 10.1093/ehjimp/qyaf068. eCollection 2025 Jul.
To determine whether atrial biomechanics measured using 3D regional strain, left atrial volume (LAV), and left atrial emptying fraction (LAEF) are associated with atrial fibrosis in patients with suspected atrial cardiomyopathy.
Cardiovascular magnetic resonance (CMR) was performed in atrial fibrillation (AF) patients ( = 47). Healthy volunteer ( = 41) and familial dilated cardiomyopathy (DCM) ( = 31) cohorts were acquired for normalization and validation, respectively. Fibrosis was quantified using late gadolinium enhancement (LGE)-CMR, and 3D regional strain was quantified using feature tracking. Machine learning classifiers were used to classify regional severe fibrosis (>30% LGE enhancement) using regional strain and global measures of atrial anatomy and function. 3D regional strain measures (peak reservoir strain or first/second strain principal component) alone were not associated with regional fibrosis (accuracies ≤ 56.0%) in the AF cohort. Severe fibrosis was found primarily in the lateral (85.1% of AF patients) and posterior (66.0%) regions. In AF patients, the classifier incorporating LAV, LAEF, and regional location was associated with severe regional fibrosis (AUC = 0.86 ± 0.06, accuracy = 79.4 ± 6.2%), while in familial DCM patients, the accuracy was lower (62.8%).
There is a distinctive pattern of fibrosis that develops with progression of atrial cardiomyopathy, irrespective of cause. Global measures reflecting overall atrial anatomy (LAV) and function (LAEF), rather than localized regional 3D strain, were associated with severe regional fibrosis. These data suggest that regional atrial 3D strain alone is not a reliable surrogate for severe regional fibrosis.
确定使用三维区域应变、左心房容积（LAV）和左心房排空分数（LAEF）测量的心房生物力学是否与疑似心房心肌病患者的心房纤维化相关。
对心房颤动（AF）患者（n = 47）进行了心血管磁共振（CMR）检查。分别获取健康志愿者（n = 41）和家族性扩张型心肌病（DCM）患者（n = 31）队列用于标准化和验证。使用延迟钆增强（LGE）-CMR对纤维化进行定量，使用特征跟踪对三维区域应变进行定量。使用机器学习分类器，利用区域应变以及心房解剖结构和功能的整体测量指标，对区域严重纤维化（LGE增强>30%）进行分类。在AF队列中，单独的三维区域应变测量指标（峰值储备应变或第一/第二应变主成分）与区域纤维化无关（准确率≤56.0%）。严重纤维化主要见于外侧（85.1%的AF患者）和后侧（66.0%）区域。在AF患者中，纳入LAV、LAEF和区域位置的分类器与严重区域纤维化相关（AUC = 0.86±0.06，准确率 = 79.4±6.2%），而在家族性DCM患者中，准确率较低（62.8%）。
无论病因如何，随着心房心肌病的进展会出现一种独特的纤维化模式。反映心房整体解剖结构（LAV）和功能（LAEF）的整体测量指标，而非局部的三维区域应变，与严重区域纤维化相关。这些数据表明，单独的心房三维区域应变并非严重区域纤维化的可靠替代指标。
