Association between Left Atrial Late Gadolinium Enhancement and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA)

Tarek Zghaib; Thiago Quinaglia A C Silva; Bharath Ambale-Venkatesh; Eric Xie; Mohammad R Ostovaneh; Mohammadali Habibi; David A Bluemke; Elsayed Z Soliman; Colin O Wu; Susan R Heckbert; Saman Nazarian; João A C Lima

doi:10.1148/ryct.220047

Association between Left Atrial Late Gadolinium Enhancement and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA)

Radiol Cardiothorac Imaging. 2023 Jul 13;5(4):e220047. doi: 10.1148/ryct.220047. eCollection 2023 Aug.

Affiliation

¹ From the Departments of Medicine (T.Z., E.X.) and Cardiology (T.Z., T.Q.A.C.S., M.R.O., M.H., J.A.C.L.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287; Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Md (B.A.V.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (S.N.).

Abstract

Purpose: To determine the prevalence and correlates of left atrial (LA) late gadolinium enhancement (LGE) at cardiac MRI and its association with atrial fibrillation (AF) in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA).

Materials and methods: In this secondary post hoc analysis of the MESA cohort (ClinicalTrials.gov no. NCT00005487), participants without AF underwent LGE cardiac MRI at the fifth examination (2010-2012). LA LGE burden was quantified using the image intensity ratio technique on biplane long-axis two-dimensional (2D) LGE images without fat saturation. Survival analysis was performed with log-rank testing and Cox regression.

Results: Of 1697 participants (mean age, 67 years ± 9 [SD]; 872 men), 1035 (61%) had LA LGE, and 75 (4.4%) developed AF during follow-up (median, 3.95 years). At univariable analysis, LA LGE was associated with age (β = .010 [95% CI: .005, .015], P < .001), diastolic blood pressure (β = .005 [95% CI: .001, .009], P = .02), HbA1c level (β = .06 [95% CI: .02, .11], P = .009), heart failure (β = .60 [95% CI: .11, 1.08], P = .02), LA volume (β = .008 [95% CI: .004, .012], P < .001), and LA function (emptying fraction, LA global longitudinal strain, LA early diastolic peak longitudinal strain rate, and LA late diastolic peak strain rate; all P < .05). After adjusting for the variables in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) AF score, LA LGE independently helped predict incident AF (hazard ratio = 1.46 [95% CI: 1.13, 1.88], P = .003). The highest tertile (LGE > 2%) was twice as likely to develop AF.

Conclusion: Although limited by the 2D LGE technique employed, LA LGE was associated with adverse atrial remodeling and helped predict AF in a multiethnic population-based sample.Clinical trial registration no. NCT00005487Keywords: MR Imaging, Cardiac, Epidemiology Supplemental material is available for this article. © RSNA, 2023.

Keywords: Cardiac; Epidemiology; MR Imaging.

Associated data

ClinicalTrials.gov/NCT00005487