Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance: a new method to standardize the thresholds for reproducibility. Benito, E. M., Carlosena-Remirez, A., Guasch, E., Prat-González, S., Perea, R. J., Figueras, R., Borràs, R., Andreu, D., Arbelo, E., Tolosana, J. M., Bisbal, F., Brugada, J., Berruezo, A., & Mont, L. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 19(8):1272–1279, August, 2017.
doi  abstract   bibtex   
Aims: Identification of left atrial (LA) fibrosis through late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) remains controversial due to the heterogeneity and lack of reproducibility of proposed methods. Our aim is to describe a normalized, reproducible, standardized method to evaluate LA fibrosis through LGE-CMR. Methods and results: Electrocardiogram- and respiratory-gated 3-Tesla LGE-CMR was performed in 10 healthy young volunteers and 30 patients with atrial fibrillation (AF): 10 with paroxysmal AF, 10 with persistent AF, and 10 with a previous AF ablation procedure. Local image intensity ratio (IIR) of the LA was calculated as the absolute pixel intensity to mean blood pool intensity ratio. The healthy atrial tissue threshold was defined in young healthy volunteers (upper limit of normality set at IIR tissue mean plus 2 SDs). Dense atrial scarring was characterized in patients with previous radiofrequency-induced scarring (post-AF ablation patients). Validation groups consisted of patients with paroxysmal and persistent AFs. The upper limit of normal IIR was 1.20; IIR values higher than 1.32 (60% of mean maximum pixel intensity in post-ablation patients) were considered dense scar. Image intensity ratio values between 1.2 and 1.32 identified interstitial fibrosis. Patients with paroxysmal and persistent AFs had less atrial fibrotic tissue compared with post-ablation patients. Endocardial bipolar voltage was correlated to IIR values. Conclusions: An IIR of 1.2 identifies the upper limit of normality in healthy young individuals. An IIR of \textgreater1.32 defines dense atrial fibrosis in post-ablation patients. Our results provide a consistent, comparable, and normalized tool to assess atrial arrhythmogenic substrate.
@article{benito_left_2017,
	title = {Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance: a new method to standardize the thresholds for reproducibility},
	volume = {19},
	issn = {1532-2092},
	shorttitle = {Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance},
	doi = {10.1093/europace/euw219},
	abstract = {Aims: Identification of left atrial (LA) fibrosis through late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) remains controversial due to the heterogeneity and lack of reproducibility of proposed methods. Our aim is to describe a normalized, reproducible, standardized method to evaluate LA fibrosis through LGE-CMR.
Methods and results: Electrocardiogram- and respiratory-gated 3-Tesla LGE-CMR was performed in 10 healthy young volunteers and 30 patients with atrial fibrillation (AF): 10 with paroxysmal AF, 10 with persistent AF, and 10 with a previous AF ablation procedure. Local image intensity ratio (IIR) of the LA was calculated as the absolute pixel intensity to mean blood pool intensity ratio. The healthy atrial tissue threshold was defined in young healthy volunteers (upper limit of normality set at IIR tissue mean plus 2 SDs). Dense atrial scarring was characterized in patients with previous radiofrequency-induced scarring (post-AF ablation patients). Validation groups consisted of patients with paroxysmal and persistent AFs. The upper limit of normal IIR was 1.20; IIR values higher than 1.32 (60\% of mean maximum pixel intensity in post-ablation patients) were considered dense scar. Image intensity ratio values between 1.2 and 1.32 identified interstitial fibrosis. Patients with paroxysmal and persistent AFs had less atrial fibrotic tissue compared with post-ablation patients. Endocardial bipolar voltage was correlated to IIR values.
Conclusions: An IIR of 1.2 identifies the upper limit of normality in healthy young individuals. An IIR of {\textgreater}1.32 defines dense atrial fibrosis in post-ablation patients. Our results provide a consistent, comparable, and normalized tool to assess atrial arrhythmogenic substrate.},
	language = {eng},
	number = {8},
	journal = {Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology},
	author = {Benito, Eva M. and Carlosena-Remirez, Alicia and Guasch, Eduard and Prat-González, Susana and Perea, Rosario J. and Figueras, Rosa and Borràs, Roger and Andreu, David and Arbelo, Elena and Tolosana, J. Maria and Bisbal, Felipe and Brugada, Josep and Berruezo, Antonio and Mont, Lluis},
	month = aug,
	year = {2017},
	pmid = {27940935},
	keywords = {Action Potentials, Adolescent, Adult, Aged, Atrial Fibrillation, Atrial Remodeling, Atrial fibrillation, Atrial fibrosis, Cardiac-Gated Imaging Techniques, Case-Control Studies, Catheter Ablation, Catheter ablation, Contrast Media, Electrocardiography, Electrophysiologic Techniques, Cardiac, Female, Fibrosis, Heart Atria, Humans, Late gadolinium enhancement, Magnetic Resonance Imaging, Magnetic resonance, Male, Middle Aged, Organometallic Compounds, Predictive Value of Tests, Reference Values, Reproducibility of Results, Young Adult},
	pages = {1272--1279},
}
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