Quantification of left atrial function by the area-length method overestimates left atrial emptying fraction

Sophia Z. Liu; Anthony Maroun; Justin J. Baraboo; Amanda L. DiCarlo; Daniel C. Lee; Susan R. Heckbert; Rod Passman; Michael Markl; Philip Greenland; Maurice Pradella

doi:10.1016/j.ejrad.2023.110705

Quantification of left atrial function by the area-length method overestimates left atrial emptying fraction

Sophia Z. Liu, Anthony Maroun, Justin J. Baraboo, Amanda L. DiCarlo, Daniel C. Lee, Susan R. Heckbert, Rod Passman, Michael Markl, Philip Greenland, Maurice Pradella^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Purpose: The biplane area-length method is commonly used in cardiac magnetic resonance (CMR) to assess left atrial (LA) volume (LAV) and function. Associations between left atrial emptying fraction (LAEF) and clinical outcomes have been reported. However, only limited data are available on the calculation of LAEF using the biplane method compared to 3D assessment. This study aimed to compare volumetric and functional LA parameters obtained from the biplane method with 3D assessment in a large, multiethnic cohort. Method: 158 participants of MESA (Multi-Ethnic Study of Atherosclerosis) underwent CMR that included standard two- and four-chamber steady-state free precession (SSFP) cine imaging for the biplane method. For 3D-based assessment, short-axis SSFP cine series covering the entire LA were obtained, followed by manual delineation of LA contours to create a time-resolved 3D LAV dataset. Paired t-tests and Bland-Altman plots were used to analyze the data. Results: Standard volumetric assessment showed that LAV_min (bias: −8.35 mL, p < 0.001), LAV_max (bias: −9.38 mL, p < 0.001) and LAV_preA (bias: −10.27 mL, p < 0.001) were significantly smaller using the biplane method compared to 3D assessment. Additionally, the biplane method reported significantly higher LAEF_total (bias: 7.22 %, p < 0.001), LAEF_active (bias: 6.08 %, p < 0.001), and LAEF_passive (bias: 4.51 %, p < 0.001) with wide limits of agreement. Conclusions: LA volumes were underestimated using the biplane method compared to 3D assessment, while LAEF parameters were overestimated. These findings demonstrate a lack of precision using the biplane method for LAEF assessment. Our results support the usage of 3D assessment in specific settings when LA volumetric and functional parameters are in focus.

Original language	English (US)
Article number	110705
Journal	European journal of radiology
Volume	160
DOIs	https://doi.org/10.1016/j.ejrad.2023.110705
State	Published - Mar 2023

Funding

This work was supported by contracts 75N92020D00001 , HHSN268201500003I , N01-HC-95159 , 75N92020D00005 , N01-HC-95160 , 75N92020D00002 , N01-HC-95161 , 75N92020D00003 , N01-HC-95162 , 75N92020D00006 , N01-HC-95163 , 75N92020D00004 , N01-HC-95164 , 75N92020D00007 , N01-HC-95165 , N01-HC-95166 , N01-HC-95167 , N01-HC-95168 and N01-HC-95169 and grant R01HL127659 from the National Heart, Lung, and Blood Institute , and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). This research was also supported by an American Heart Association Strategically Focused Research Network on atrial fibrillation, Project Number: 18SFRN34110170. The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org . M.P. is currently an AHA postdoctoral research fellow at the Department of Radiology, Northwestern University, and is supported by the Bangerter-Rhyner Foundation and Freiwillige Akademische Gesellschaft Basel.

Keywords

Biplane area-length method
Cardiac MRI
Left atrial emptying fraction
Left atrial function
Left atrial volume

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1016/j.ejrad.2023.110705

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@article{94eb8678f84e4f46ab9f33a0ee4cddeb,

title = "Quantification of left atrial function by the area-length method overestimates left atrial emptying fraction",

abstract = "Purpose: The biplane area-length method is commonly used in cardiac magnetic resonance (CMR) to assess left atrial (LA) volume (LAV) and function. Associations between left atrial emptying fraction (LAEF) and clinical outcomes have been reported. However, only limited data are available on the calculation of LAEF using the biplane method compared to 3D assessment. This study aimed to compare volumetric and functional LA parameters obtained from the biplane method with 3D assessment in a large, multiethnic cohort. Method: 158 participants of MESA (Multi-Ethnic Study of Atherosclerosis) underwent CMR that included standard two- and four-chamber steady-state free precession (SSFP) cine imaging for the biplane method. For 3D-based assessment, short-axis SSFP cine series covering the entire LA were obtained, followed by manual delineation of LA contours to create a time-resolved 3D LAV dataset. Paired t-tests and Bland-Altman plots were used to analyze the data. Results: Standard volumetric assessment showed that LAVmin (bias: −8.35 mL, p < 0.001), LAVmax (bias: −9.38 mL, p < 0.001) and LAVpreA (bias: −10.27 mL, p < 0.001) were significantly smaller using the biplane method compared to 3D assessment. Additionally, the biplane method reported significantly higher LAEFtotal (bias: 7.22 %, p < 0.001), LAEFactive (bias: 6.08 %, p < 0.001), and LAEFpassive (bias: 4.51 %, p < 0.001) with wide limits of agreement. Conclusions: LA volumes were underestimated using the biplane method compared to 3D assessment, while LAEF parameters were overestimated. These findings demonstrate a lack of precision using the biplane method for LAEF assessment. Our results support the usage of 3D assessment in specific settings when LA volumetric and functional parameters are in focus.",

keywords = "Biplane area-length method, Cardiac MRI, Left atrial emptying fraction, Left atrial function, Left atrial volume",

author = "Liu, {Sophia Z.} and Anthony Maroun and Baraboo, {Justin J.} and DiCarlo, {Amanda L.} and Lee, {Daniel C.} and Heckbert, {Susan R.} and Rod Passman and Michael Markl and Philip Greenland and Maurice Pradella",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

year = "2023",

month = mar,

doi = "10.1016/j.ejrad.2023.110705",

language = "English (US)",

volume = "160",

journal = "European journal of radiology",

issn = "0720-048X",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Quantification of left atrial function by the area-length method overestimates left atrial emptying fraction

AU - Liu, Sophia Z.

AU - Maroun, Anthony

AU - Baraboo, Justin J.

AU - DiCarlo, Amanda L.

AU - Lee, Daniel C.

AU - Heckbert, Susan R.

AU - Passman, Rod

AU - Markl, Michael

AU - Greenland, Philip

AU - Pradella, Maurice

PY - 2023/3

Y1 - 2023/3

N2 - Purpose: The biplane area-length method is commonly used in cardiac magnetic resonance (CMR) to assess left atrial (LA) volume (LAV) and function. Associations between left atrial emptying fraction (LAEF) and clinical outcomes have been reported. However, only limited data are available on the calculation of LAEF using the biplane method compared to 3D assessment. This study aimed to compare volumetric and functional LA parameters obtained from the biplane method with 3D assessment in a large, multiethnic cohort. Method: 158 participants of MESA (Multi-Ethnic Study of Atherosclerosis) underwent CMR that included standard two- and four-chamber steady-state free precession (SSFP) cine imaging for the biplane method. For 3D-based assessment, short-axis SSFP cine series covering the entire LA were obtained, followed by manual delineation of LA contours to create a time-resolved 3D LAV dataset. Paired t-tests and Bland-Altman plots were used to analyze the data. Results: Standard volumetric assessment showed that LAVmin (bias: −8.35 mL, p < 0.001), LAVmax (bias: −9.38 mL, p < 0.001) and LAVpreA (bias: −10.27 mL, p < 0.001) were significantly smaller using the biplane method compared to 3D assessment. Additionally, the biplane method reported significantly higher LAEFtotal (bias: 7.22 %, p < 0.001), LAEFactive (bias: 6.08 %, p < 0.001), and LAEFpassive (bias: 4.51 %, p < 0.001) with wide limits of agreement. Conclusions: LA volumes were underestimated using the biplane method compared to 3D assessment, while LAEF parameters were overestimated. These findings demonstrate a lack of precision using the biplane method for LAEF assessment. Our results support the usage of 3D assessment in specific settings when LA volumetric and functional parameters are in focus.

AB - Purpose: The biplane area-length method is commonly used in cardiac magnetic resonance (CMR) to assess left atrial (LA) volume (LAV) and function. Associations between left atrial emptying fraction (LAEF) and clinical outcomes have been reported. However, only limited data are available on the calculation of LAEF using the biplane method compared to 3D assessment. This study aimed to compare volumetric and functional LA parameters obtained from the biplane method with 3D assessment in a large, multiethnic cohort. Method: 158 participants of MESA (Multi-Ethnic Study of Atherosclerosis) underwent CMR that included standard two- and four-chamber steady-state free precession (SSFP) cine imaging for the biplane method. For 3D-based assessment, short-axis SSFP cine series covering the entire LA were obtained, followed by manual delineation of LA contours to create a time-resolved 3D LAV dataset. Paired t-tests and Bland-Altman plots were used to analyze the data. Results: Standard volumetric assessment showed that LAVmin (bias: −8.35 mL, p < 0.001), LAVmax (bias: −9.38 mL, p < 0.001) and LAVpreA (bias: −10.27 mL, p < 0.001) were significantly smaller using the biplane method compared to 3D assessment. Additionally, the biplane method reported significantly higher LAEFtotal (bias: 7.22 %, p < 0.001), LAEFactive (bias: 6.08 %, p < 0.001), and LAEFpassive (bias: 4.51 %, p < 0.001) with wide limits of agreement. Conclusions: LA volumes were underestimated using the biplane method compared to 3D assessment, while LAEF parameters were overestimated. These findings demonstrate a lack of precision using the biplane method for LAEF assessment. Our results support the usage of 3D assessment in specific settings when LA volumetric and functional parameters are in focus.

KW - Biplane area-length method

KW - Cardiac MRI

KW - Left atrial emptying fraction

KW - Left atrial function

KW - Left atrial volume

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JO - European journal of radiology

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ER -

Quantification of left atrial function by the area-length method overestimates left atrial emptying fraction

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