Left Atrial Time-to-Peak From Time-Resolved MR Angiography as a Noninvasive Indicator of Left Atrial Pressure Before Catheter Ablation of Atrial Fibrillation
- Author:
Jaemin SHIM
1
;
Soojung PARK
;
Yu-Whan OH
;
Yun Gi KIM
;
Jong-Il CHOI
;
Sung Ho HWANG
Author Information
- Publication Type:Original Article
- From:Korean Journal of Radiology 2026;27(5):419-427
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:To evaluate the performance of the left atrial time-to-peak (TTP) derived from time-resolved magnetic resonance angiography (TR-MRA) as a noninvasive indicator of left atrial pressure (LAP) in patients with atrial fibrillation (AF).
Materials and Methods:This retrospective study included 92 patients who underwent cardiac TR-MRA and catheter-based LAP measurements prior to catheter ablation for AF between January 2021 and December 2022. TR-MRA–derived TTP was measured in the left atrium using contrast-enhanced time-signal intensity curves. Catheter-based LAP measured during sinus rhythm served as the reference standard, with high LAP defined as ≥15 mmHg. Univariable and multivariable linear regression analyses were performed, with LAP as the dependent variable and echocardiographic parameters as covariates. The diagnostic performance of TTP for high LAP was evaluated using receiver operating characteristic (ROC) curve analysis.
Results:Among the 92 patients (mean age ± standard deviation, 60 ± 10 years; 70 male), 70 (76.0%) had low LAP, and 22 (23.9%) had high LAP. Mean TTP was significantly longer in patients with high LAP than in those with low LAP (25.1 ± 6.9 s vs.16.9 ± 5.7 s, P < 0.001). In multivariable linear regression analysis, TTP remained independently associated with LAP (β = 0.46, P < 0.001). ROC analysis demonstrated good discriminative performance of TTP for identifying high LAP, with an area under the curve of 0.834 (95% confidence interval, 0.742–0.904). Using a TTP cutoff of >19.6 seconds, the sensitivity and specificity for identifying elevated LAP levels were 81.8% (18/22) and 75.7% (53/70), respectively.
Conclusion:TR-MRA–derived TTP showed a significant independent association with invasively measured LAP. It may serve as a reliable noninvasive imaging marker for identifying high LAP in patients with AF undergoing catheter ablation.
