Diffuse Ventricular Fibrosis in Atrial Fibrillation
Open accessAbstract
Objectives The purpose of this study was to evaluate diffuse myocardial fibrosis of the left ventricle (LV) in patients with atrial fibrillation (AF).Background Diffuse myocardial fibrosis is a hallmark of cardiomyopathy. Unlike replacement fibrosis, it is not visualized on delayed-enhancement cardiac magnetic resonance (CMR) imaging, but may be quantified with contrast-enhanced T(1) mapping methods. In atrial fibrillation (AF), it may be induced by arrhythmia or reflect pre-existing cardiomyopathy.Methods Ninety subjects underwent CMR using a clinical 1.5-T scanner: 23 controls, 40 paroxysmal AF patients, and 27 persistent AF patients. Cardiac morphology and function was evaluated from CMR cine imaging. A histologically validated T(1) mapping sequence was used to calculate post-contrast T(1) relaxation time (T(1) time) of the LV myocardium as an index of diffuse myocardial fibrosis.Results Age was similar across controls, paroxysmal AF patients, and persistent AF patients (54 ± 12 years, 58 ± 9 years, and 56 ± 10 years, p = NS). Persistent AF patients had larger indexed left atrium volume (55 ± 18 ml vs. 41 ± 12 ml and 47 ± 14 ml) and lower ejection fraction (54 ± 10% vs. 65 ± 6% and 61 ± 8%) than controls and paroxysmal AF patients (p < 0.05). Post-contrast ventricular T(1) time differed across all groups (controls, 535 ± 86 ms; paroxysmal AF, 427 ± 95 ms; persistent AF, 360 ± 84 ms; p < 0.001). Univariate predictors of post-contrast ventricular T(1) time included age, sex, AF category, ejection fraction, LV mass, congestive heart failure, and body mass index. After multivariate analysis, age, AF category, and ejection fraction remained independent predictors.Conclusions Post-contrast ventricular T(1) mapping identifies diffuse LV fibrosis in patients with AF and provides new insights into the association between AF and adverse ventricular remodeling.
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Delayed-enhancement MRI of the left atrium using gadolinium contrast, T1 mapping using cardiac MRI, and intracardiac echo may help to guide treatment decisions in AF, but require external validation in multicentre studies.
“Delayed-enhancement MRI of the left atrium using gadolinium contrast, [345][346][347] T1 mapping using cardiac MRI, 347 and intracardiac echo 348 may help to guide treatment decisions in AF, but require external validation in multicentre studies.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [347]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Ling, L.-H., Kistler, P. M., Ellims, A. H., Iles, L. M., Lee, G., Hughes, G. L., Kalman, J. M., Kaye, D. M., & Taylor, A. J.
- Affiliations
- The Royal Melbourne Hospital (AU)
- Baker Heart and Diabetes Institute (AU)
- Corresponding author
- Taylor, Andrew J.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 60
- Issue
- 23
- Pages
- 2402-2408
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W184145030
- Cited by
- 157
- References
- 35
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 7 · 2023: 8 · 2022: 10 · 2021: 13 · 2020: 15 · 2019: 4 · 2018: 11 · 2017: 14 · 2016: 13 · 2015: 17 · 2014: 15 · 2013: 13 · 2012: 1
- FWCI
- 9.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- NHMRC
- NHF
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- atrial fibrillation, diffuse myocardial fibrosis, left ventricular fibrosis, T1 mapping, ventricular remodeling, paroxysmal atrial fibrillation, persistent atrial fibrillation, left atrial volume, ejection fraction, cardiac magnetic resonance
- MeSH terms
- Aged, Aging, Atrial Fibrillation, Female, Fibrosis, Follow-Up Studies, Humans, Male, Middle Aged, Cardiomyopathies, Myocardium, Retrospective Studies, Systole, Disease Progression, Ventricular Dysfunction, Left, Magnetic Resonance Imaging, Cine
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