Arrhythmias

1350391 - Application of Bright-blood and black-blood phase sensitive inversion recovery (BOOST) sequence for left atrial visualization in patients with atrial fibrillation

Friday, January 27, 2023

12:20 PM – 1:20 PM

Location: Pacific Jewel

Presenting Author(s)

ZD

Zsofia Dohy, MD

Cardiology fellow
Semmelweis University
Budapest, Hungary

Primary Author(s)

ZD

Zsofia Dohy, MD

Cardiology fellow
Semmelweis University
Budapest, Hungary

Co-Author(s)

MK

Mate Kiss

Clinical Scientist
Siemens Healthcare Hungary
Budapest, Hungary
KK

Karl P. Kunze, PhD

Senior Cardiac MR Scientist
Siemens Healthineers
London, England, United Kingdom
RN

Radhouene Neji, PhD

Siemens Research Scientist
King's College London, United Kingdom
GO

Gabor Orban

PhD fellow
Semmelweis University, Hungary
ZD

Zsofia Drobni, MD, PhD

Cardiology fellow
Semmelweis University, Hungary
FS

Ferenc Imre. Suhai, MD

Radiologist
Semmelweis University
Budapest, Pest, Hungary
CC

Csilla Czimbalmos, MD, PhD

Cardiologist
Semmelweis University
Budapest, Budapest, Hungary
LS

Liliana Szabo, MD, PhD

Clinical researcher
Semmelweis University, Hungary
René M. Botnar, PhD

Professor
King's College London
London, England, United Kingdom
Claudia Prieto, PhD

Professor
King's College London
London, United Kingdom
NS

Nandor Szegedi, MD, PhD

Assistant professor
Semmelweis University, Hungary
BM

Bela Merkely, MD, PhD

Professor
Semmelweis University, Hungary
HV

Hajnalka Vago, MD, PhD

Associate professor
Semmelweis University, Hungary

Disclosure(s):

René M. Botnar, PhD: No financial relationships to disclose

Background: Imaging of left atrium (LA) in atrial fibrillation (AF) influences the therapeutic management of patients. Visualizing LA anatomy including the pulmonary veins (PV) is important for planning the procedure of pulmonary vein isolation with ablation. A novel 3D whole-heart bright-blood and black-blood phase sensitive (BOOST) inversion recovery MRI sequence that does not require contrast administration and is performed during free-breathing using image-based navigation has been introduced recently. The aims of our study are to investigate the feasibility of BOOST in patients with AF scheduled for ablation or electro cardioversion, analyze the image quality with both quantitative- and qualitative methods, and to investigate the correlation between image quality and heart rate and rhythm of patients.

Methods: CMR examinations were performed on a 1.5 T MR scanner (MAGNETOM Aera, Siemens Healthcare, Germany). A prototype BOOST sequence was performed for assessing pulmonary veins (PV) both with T2-preparation pre-pulse (T2prep) and MT-preparation (MTC) in 45 patients with paroxysmal or permanent AF scheduled for ablation or electro cardioversion. Thirty patients had sinus rhythm, 15 patients had atrial tachyarrhythmia (12 AF, 2 atrial flutter, 1 atrial tachycardia) at the time of the CMR examination. Image quality analyses were performed by two independent observers both on bright-blood magnitude and black-blood phase-sensitive inversion recovery (PSIR) images. Qualitative assessment was made using Likert scale (1 point: poor image quality, PVs are not detected; 2 points: good image quality, artifacts in the PV(s); 3 points: excellent image quality, no artifacts), for quantitative analysis signal to noise ratios (SNR) and contrast to noise ratios (CNR) were calculated for each PV. Heart rate and rhythm was analyzed based on standard 12-lead ECGs.

Results: All MTC BOOST acquisitions achieved diagnostic quality in the PVs, while a significant proportion of T2prep BOOST images were not suitable for assessing PVs. In the case of sinus rhythm, the observers gave a higher proportion of 3 points compared to atrial tachyarrhythmia cases (Table 1). SNR and CNR values of the MTC magnitude images were higher if patients had sinus rhythm in the majority of PVs (Table 2). We did not find a significant difference in SNR and CNR values between patients with sinus rhythm and atrial tachyarrhythmia on the PSIR images. We found a significant or nearly significant negative correlation between heart rate and the SNR and CNR values of MTC magnitude images. The SNR and CNR values of PSIR images did not correlate with the heart rate.

Conclusion: 3D whole-heart MTC BOOST imaging is suitable for visualizing the PVs in patients with AF, producing diagnostic image quality in 100% of cases. However, the overall image quality of magnitude images was influenced by heart rate and rhythm.