A novel, non-invasive, integral imaging assessment in atrial fibrillation by cardiac tomography

Objective: The objective of the study was to analyze the clinical utility and feasibility of the multidetector cardiac tomography (MDCT) in multi-parametric imaging assessment in atrial fibrillation (AF) patients. Materials and methods: This was a prospective case-control study in 84 subjects (54 AF subjects and 30 healthy subjects). Left atrial appendage (LAA) morphology was classified as: cactus, chicken wing, wind sock, and cauliflower. Intra-cardiac thrombus, stroke history, and CHA(2)DS(2)-VASC scale were compared to cardiac MDCT atrial imaging assessment. Results: Left atrial ejection fraction (LAEF) and LAA ejection fraction (LAAEF) were lower in AF subjects (p < 0.001), left atrial volume index (LAVI) was higher in AF subjects (p < 0.001). An inverse correlation between LAEF and LAVI was found (r = -0.38, p < 0.001). Cauliflower LAA morphology frequency was higher in AF subjects, whereas cactus LAA morphology frequency was higher in controls. Cauliflower LAA morphology was associated with thrombus presence (p < 0.01) as well as a higher CHA(2)DS(2)-VASc score. Flow velocity was lower in AF subject compared to controls (p < 0.001). Conclusion: MDCT is a novel, non-invasive, worldwide available method for an integral assessment in AF. Our results could improve precision, clinical utility, and risk stratification analysis in AF. Our proposal is to include this new method into the global cardiovascular and thrombotic risk assessment in AF patients.