Left atrial wall thickness in paroxysmal atrial fibrillation by multislice-CT is initial marker of structural remodeling and predictor of transition from paroxysmal to chronic form

• Published in: International journal of cardiology Vol. 148; no. 2; pp. 139 - 147
• Main Authors: Nakamura, Koki, Funabashi, Nobusada, Uehara, Masae, Ueda, Marehiko, Murayama, Taichi, Takaoka, Hiroyuki, Komuro, Issei
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 14.04.2011; Elsevier
• Subjects: Acute Disease; Aged; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - pathology; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiomegaly - diagnostic imaging; Cardiomegaly - pathology; Cardiovascular; Chronic Disease; Disease Progression; Echocardiography; Female; Fibrosis; Heart; Heart Atria - diagnostic imaging; Heart Atria - pathology; Humans; Initial marker; Left atrial wall thickness; Male; Medical sciences; Middle Aged; Multislice-CT; Myocardium - pathology; Paroxysmal atrial fibrillation; Predictive Value of Tests; ROC Curve; Stroke Volume; Structural remodeling; Tomography, X-Ray Computed - methods; Transition from paroxysmal to chronic form; Left atrial wall thickness; Multislice-CT; Paroxysmal atrial fibrillation; Structural remodeling; Transition from paroxysmal to chronic form; Initial marker; Radiodiagnosis; Arrhythmia; Predictor; Atrial fibrillation; Multislice-Cr; Biological marker; Cardiovascular disease; Left atrium; Wall thickness; Excitability disorder; Vascular remodeling; Chronic; Heart disease; Transition; Medical imagery; Multislice; Computerized axial tomography; Cardiology; Predictive factor
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2009.10.032

Abstract Purpose We used ECG-gated MSCT to evaluate alterations in the LA wall in patients with paroxysmal atrial fibrillation (AF) (PAF) and compared with chronic AF (CAF) and normal sinus rhythm (NSR). Materials and methods We enrolled 3 groups, each consisting of 62 patients with either recurrent PAF (48 males, 65 ± 11 years), CAF (43 males, 69 ± 9 years), or NSR without any history of AF (40 males, 64 ± 11 years) for a total of 186 study patients. In CT, the absolute LA wall thickness (LAT) and LA volumes were calculated. Results In CT, patients with PAF had significantly thicker LAT than those with either CAF or NSR (2.4 ± 0.2 mm in PAF > 2.1 ± 0.2 mm in CAF or 1.9 ± 0.2 mm in NSR, p < 0.01). Patients with CAF had significantly larger LA volume than those with either PAF or NSR ( p < 0.01). Subsequently, 9 of the 62 patients with PAF developed CAF over a mean follow-up period of 19 ± 22 months. The mean LAT was significantly thinner in patients who had transitioned from PAF to CAF than in those who had not (2.2 ± 0.2 mm and 2.4 ± 0.2 mm, respectively) ( p < 0.01). Receiver operating characteristic analysis demonstrated that the area under the curve for LAT was greater than that for LA volume in CT and LAD in transthoracic echocardiogram. In the Kaplan–Meier analysis, the transition from PAF to CAF was observed more frequently in patients with LAT < 2.4 mm than LAT ≥ 2.4 mm ( p = 0.018). Conclusions Alteration of the LA wall may suggest a part of structural remodeling in AF before the occurrence of LA dilatation. LAT in CT seems to be a useful predictor of the transition from PAF to CAF in patients with PAF.