Novel Computational Analysis of Left Atrial Anatomy Improves Prediction of Atrial Fibrillation Recurrence after Ablation
Varela, Marta (King's College London)
Bisbal, Felipe (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Zacur, Ernesto (King's College London)
Berruezo, Antonio (Hospital Clínic i Provincial de Barcelona)
Aslanidi, Oleg V. (King's College London)
Mont, Lluis (Hospital Clínic i Provincial de Barcelona)
Lamata, Pablo (King's College London)

Fecha:	2018
Resumen:	The left atrium (LA) can change in size and shape due to atrial fibrillation (AF)-induced remodeling. These alterations can be linked to poorer outcomes of AF ablation. In this study, we propose a novel comprehensive computational analysis of LA anatomy to identify what features of LA shape can optimally predict post-ablation AF recurrence. To this end, we construct smooth 3D geometrical models from the segmentation of the LA blood pool captured in pre-procedural MR images. We first apply this methodology to characterize the LA anatomy of 144 AF patients and build a statistical shape model that includes the most salient variations in shape across this cohort. We then perform a discriminant analysis to optimally distinguish between recurrent and non-recurrent patients. From this analysis, we propose a new shape metric called vertical asymmetry, which measures the imbalance of size along the anterior to posterior direction between the superior and inferior left atrial hemispheres. Vertical asymmetry was found, in combination with LA sphericity, to be the best predictor of post-ablation recurrence at both 12 and 24 months (area under the ROC curve: 0. 71 and 0. 68, respectively) outperforming other shape markers and any of their combinations. We also found that model-derived shape metrics, such as the anterior-posterior radius, were better predictors than equivalent metrics taken directly from MRI or echocardiography, suggesting that the proposed approach leads to a reduction of the impact of data artifacts and noise. This novel methodology contributes to an improved characterization of LA organ remodeling and the reported findings have the potential to improve patient selection and risk stratification for catheter ablations in AF.
Ayudas:	European Commission 655020
Nota:	Altres ajuts: UK Department of Health (via the NIHR comprehensive Biomedical Research Centre award to Guys & St. Thomas NHS Foundation Trust in partnership with KCL and King's College Hospital NHS Foundation Trust and the Healthcare Technology Co-operative for Cardiovascular Disease); British Heart Foundation [PG/15/8/31130]; La MARATO - TV3 (ID 201527).
Nota:	Altres ajuts: WT/088641/Z/09/Z
Nota:	Altres ajuts: WT/099973/Z/12/Z
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Atrial fibrillation ; Computational anatomy ; Left atrial remodeling ; Recurrence risk assessment ; Biomarker ; Classification
Publicado en:	Frontiers in physiology, Vol. 8 (2018) , p. 1, ISSN 1664-042X

DOI: 10.3389/fphys.2017.00068
PMID: 28261103

12 p, 2.9 MB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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