Assessment of left atrial volumes in sinus rhythm and atrial fibrillation using the biplane area-length method and cardiovascular magnetic resonance Imaging with TrueFISP

Objectives: To determine whether the biplane area-length method can be used for the evaluation of left atrial volumes and ejection fraction with cardiovascular magnetic resonance imaging (CMR) by TrueFISP in normal subjects and patients with atrial fibrillation. Background: Atrial fibrillation is the most common arrhythmia in elderly patients. Left atrial size and volumes play an important role in predicting short and long-term success after cardioversion. Methods: Fifteen healthy subjects (mean age 65.6 +/- 6.4 years) and 18 patients (mean age 67.2 +/- 8.8 years) with atrial fibrillation were examined by CMR (Magnetom, Siemens, Erlangen, Germany). Images were acquired by TrueFISP using the horizontal and vertical long-axis plane to measure left atrial end-diastolic and end-systolic areas and longitudinal dimensions. Volumes were determined with commercially available software. Left atrial end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were determined by the biplane area-length method and compared to findings obtained by the standard short-axis method. Images were acquired and analyzed a second time in the patients with atrial fibrillation. Results: There was no difference in age between men and women (p = 0.147) and healthy subjects and patients (p = 0.128) included in the study. EDV and ESV were significantly higher and SV and EF significantly lower in patients with atrial fibrillation than in healthy subjects (p < 0.009), regardless of the method used. The values obtained for EDV and ESV by the biplane area-length method were significantly higher in both healthy subjects (p < 0.001) and patients with atrial fibrillation (p < 0.001) than those obtained by the standard short-axis approach, whereas SV (p greater than or equal to 0.057) and EF (p greater than or equal to 0. 118) did not differ significantly. In the second investigation in patients with atrial fibrillation, ESV, SV, and EF did not differ significantly between the two methods (p greater than or equal to 0.481). Assessment of interobserver variability revealed good agreement in the findings of the two observers, both in normal sinus rhythm and atrial fibrillation (overall variability 0.8 +/- 6.5%). Conclusions: The biplane area-length method can be used in CMR images obtained by TrueFISP to assess left atrial volumes and ejection fraction in normal subjects and patients with varying cardiac cycle length, as in atrial fibrillation.