The use of MRI in quantification of the atrial fibrosis in patients with rheumatic mitral disease

Abstract

Abstract Background Atrial fibrillation (AF) is a common type of arrhythmia with higher incidence in countries with increased prevalence of rheumatic heart disease (RHD), where AF contributes to significant morbidity and mortality in young population. Atrial fibrosis is a common feature of AF. Delayed enhancement MRI (DE-MRI) is a well-established method for characterizing fibrosis in ventricles. The use of DE-MRI to detect left atrial fibrosis helps to evaluate the extent of atrial structural remodeling non-invasively. The aim of this study is to evaluate the atrial fibrosis in patients with mitral valve disease, using the DE MRI, regarding its amount, distribution, and relation to AF. Results Patients with AF were older and have longer duration of symptoms, smaller valve area, larger LA size, and more fibrosis at the left atrium (with the posterior wall most frequently involved) in comparison to those with sinus rhythm. Patients with atrial fibrosis were older and have longer duration of symptoms, smaller valve area, and larger LA, and most of them had AF compared to those without fibrosis. The comparison between types of AF showed a significant difference in the amount of atrial fibrosis that increases across the spectrum of AF. Conclusion In patients with rheumatic mitral valve diseases, AF is associated with more atrial fibrosis as assessed by DE-MRI. Atrial fibrosis is the best independent predictor of AF.