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The reproducibility of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study

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dc.contributor.author Chubb, Henry
dc.contributor.author Karim, Rashed
dc.contributor.author Roujol, Sébastien
dc.contributor.author Nuñez-Garcia, Marta
dc.contributor.author Williams, Steven E.
dc.contributor.author Whitaker, John
dc.contributor.author Harrison, James
dc.contributor.author Butakoff, Constantine
dc.contributor.author Camara, Oscar
dc.contributor.author Chiribiri, Amedeo
dc.contributor.author Schaeffter, Tobias
dc.contributor.author Wright, Matthew
dc.contributor.author O'Neill, Mark
dc.contributor.author Razavi, Reza
dc.date.accessioned 2021-06-10T07:16:39Z
dc.date.available 2021-06-10T07:16:39Z
dc.date.issued 2018
dc.identifier.citation Chubb H, Karim R, Roujol S, Nuñez-Garcia M, Williams SE, Whitaker J, Harrison J, Butakoff C, Camara O, Chiribiri A, Schaeffter T, Wright M, O'Neill M, Razavi R. The Reproducibility of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study. JCMR. 2018;20:21. DOI: 10.1186/s12968-018-0438-y
dc.identifier.issn 1097-6647
dc.identifier.uri http://hdl.handle.net/10230/47839
dc.description.abstract Background: Cardiovascular magnetic resonance (CMR) imaging has been used to visualise post-ablation atrial scar (PAAS), generally employing a three-dimensional (3D) late gadolinium enhancement (LGE) technique. However the reproducibility of PAAS imaging has not been determined. This cross-over study is the first to investigate the reproducibility of the technique, crucial for both future research design and clinical implementation. Methods: Forty subjects undergoing first time ablation for atrial fibrillation (AF) had detailed CMR assessment of PAAS. Following baseline pre-ablation scan, two scans (separated by 48 h) were performed at three months post-ablation. Each scan session included 3D LGE acquisition at 10, 20 and 30 min post administration of gadolinium-based contrast agent (GBCA). Subjects were allocated at second scan post-ablation to identical imaging parameters (‘Repro’, n = 10), 3 T scanner (‘3 T’, n = 10), half-slice thickness (‘Half-slice’, n = 10) or half GBCA dose (‘Half-gad’, n = 10). PAAS was compared to baseline scar and then reproducibility was assessed for two measures of thresholded scar (% left atrial (LA) occupied by PAAS (%LA PAAS) and Pulmonary Vein Encirclement (PVE)), and then four measures of non-thresholded scar (point-by-point assessment of PAAS, four normalisation methods). Thresholded measures of PAAS were evaluated against procedural outcome (AF recurrence). Results: A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. At 20 and 30 min, inter-scan reproducibility was good to excellent (coefficient of variation at 20 min and 30 min: %LA PAAS 0.41 and 0.20; PVE 0.13 and 0.04 respectively for ‘Repro’ group). Changes in imaging parameters, especially reduced GBCA dose, reduced inter-scan reproducibility, but for most measures remained good to excellent (ICC for %LA PAAS 0.454–0.825, PVE 0.618–0.809 at 30 min). For non-thresholded scar, highest reproducibility was observed using blood pool z-score normalisation technique: inter-scan ICC 0.759 (absolute agreement, ‘Repro’ group). There was no significant relationship between indices of PAAS and AF recurrence. Conclusion: PAAS imaging is a reproducible finding. Imaging should be performed at least 20 min post-GBCA injection, and a blood pool z-score should be considered for normalisation of signal intensities. The clinical implications of these findings remain to be established in the absence of a simple correlation with arrhythmia outcome.
dc.description.sponsorship The research was performed at King’s College London Medical Engineering Centre, funded by the Wellcome Trust and the Engineering and Physical Sciences Research Council (EPSRC). The research was also supported by the National Institute for Health Research (NIHR) Biomedical Research Centre awards to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London, by the NIHR Healthcare Technology Co-operative for Cardiovascular Disease at Guy’s and St Thomas’ NHS Foundation Trust, and by the Cardiovascular HTC. Work upon the PVE methodology was partially funded by the Spanish Ministry of Economy and Competitiveness (DPI2015-71640-R) and by the “Fundació La Marató de TV3” (no. 20154031).
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartof Journal of Cardiovascular Magnetic Resonance. 2018;20:21
dc.rights © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
dc.rights.uri http://creativecommons.org/licenses/by/4.0/
dc.title The reproducibility of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1186/s12968-018-0438-y
dc.subject.keyword Atrial fibrillation
dc.subject.keyword Cardiac magnetic resonance imaging
dc.subject.keyword Catheter ablation
dc.subject.keyword Atrium
dc.subject.keyword Optimization
dc.subject.keyword Late gadolinium enhancement
dc.relation.projectID info:eu-repo/grantAgreement/ES/1PE/DPI2015-71640-R
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion


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