Date of Award

January 2016

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Dana C. Peters

Second Advisor

Lauren A. Baldassarre

Abstract

The purpose of this study was to evaluate the clinical conditions and cardiac functions associated with left atrial (LA) fibrosis by late gadolinium enhancement (LGE). LA LGE has been found to be associated with various measures of cardiac functions, procedural outcomes, and adverse events in patients who already have atrial fibrillation (AF). Assessment of LA fibrosis by LGE in patients without AF has largely been unexamined and comparison of these patients to those with AF could prove useful. This study was a retrospective chart and imaging review of 137 consecutive subjects imaged with a 3D LGE sequence at one institution from 2012-2014. Fibrosis by LA LGE is elevated in subjects with congestive heart failure (CHF), AF, hypertrophic cardiomyopathy (HCM), and mitral regurgitation when compared to a set of reference subjects (all p < 0.05). In multivariate analysis, HCM (p = 0.01) and CHF (p < 0.01) were independently associated with elevated LGE. Across all subjects, LA LGE was moderately correlated with minimum LA volume (r = 0.41, p < 0.01) and LA ejection fraction (r = -0.43, p < 0.01) but weakly correlated with maximum LA volume (r = 0.197, p = 0.02); these relationships were similar in subgroups with and without AF. In a subset of subjects without AF, there was a lower active atrial ejection fraction with increasing LA LGE (r = -0.438, p < 0.01). Also, after multivariate adjustment for ventricular filling measures, there was an independent association of increased LA LGE with decreased passive LA emptying (p = 0.02). Subjects with heart failure but ventricular ejection fraction >45% had greater LA LGE than those with whose ejection fraction was <45% (p = 0.03).

We found that extent of LGE correlates with the presence of CHF, AF, HCM, mitral regurgitation, and some cardiac anatomic and functional measurements. This study lays the groundwork for further evaluation of the utility of measuring LA LGE in patients without AF.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 12/31/2019.

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