Assessment of Left Ventricular Myocardial Fibrosis and Edema in Atrial Fibrillation Using Cardiovascular Magnetic Resonance

Summary

This protocol describes a standardized, one-stop cardiovascular magnetic resonance (CMR) procedure for characterizing the structure, function, and myocardial tissue properties of the left atrium and left ventricle in patients with atrial fibrillation (AF). It covers patient preparation, image acquisition, and post-processing, together with representative imaging findings in patients with AF.

Abstract

Progressive population aging has driven a steady rise in the incidence of atrial fibrillation (AF), making the management of its long-term prognosis an increasingly important clinical concern. In addition to forming a vicious cycle with progressive atrial dysfunction, AF promotes adverse remodeling and functional impairment of the ventricles, thereby increasing the risk of heart failure. Cardiovascular magnetic resonance (CMR), as the gold standard for evaluating cardiac function, cannot only accurately assess functional abnormalities of the atria and ventricles, but also its quantitative assessment techniques, including T1 mapping, T2 mapping, and extracellular volume (ECV) fraction, enable early and precise quantification of ventricular myocardial pathology. The principal aim of this study is to provide a comprehensive assessment of the left atrium and left ventricle in patients with AF using a one-stop CMR protocol based on multi-parametric quantitative myocardial analysis, providing reliable data for clinical treatment decisions, preoperative assessment, and long-term follow-up.

Introduction

Atrial fibrillation (AF), the most common form of sustained arrhythmia, is rising steadily in incidence¹. This progressive disorder typically begins with structural and functional derangement of the left atrium (LA) and ultimately leads to left ventricular (LV) dilation and impaired systolic and diastolic function, commonly evolving from a paroxysmal to a persistent form². AF is characterized by structural, electrical, and contractile remodeling of the atrium. It is also associated with systemic inflammation and diffuse fibrosis, which eventually give rise to fibrotic and inflammatory changes in the ventricle as well

Protocol

This study enrolled consecutive patients with paroxysmal atrial fibrillation who underwent CMR examination at the China-Japan Union Hospital of Jilin University between January 2024 and September 2025. The study was approved by the Ethics Committee of the China-Japan Union Hospital of Jilin University (approval number: 2021092704) and was conducted in accordance with the Declaration of Helsinki. Confidentiality of patient data was strictly maintained throughout the research.

1. Preparation before scanning

1. Accurately record the heart rate, blood pressure, weight, and height.
2. Exclude contraindications to....

Results

Statistical analyses

All analyses were performed with SPSS 29. For the baseline information and quantitative parameters of CMR, if the indicators followed a normal distribution, they were expressed as mean ± standard deviation; if they did not follow a normal distribution, they were represented by median and interquartile range. The comparison of measurement data or count data between the two groups was conducted using the two-independent-sample t-test or the χ^2<.......

Discussion

Atrial fibrillation (AF) is among the most common arrhythmias, and its principal pathological basis is well recognized to be structural, electrical, and functional remodeling of the left atrium. For this reason, attention has traditionally centered on structural and functional changes of the atrium. The major adverse consequence of AF is the induction of new heart failure or the aggravation of pre-existing heart failure, a process that may be mechanistically linked to left ventricular interstitial fibrosis and inflammati.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
cvi42 CMR Analysis Software	Circle Cardiovascular Imaging (Canada)	www.circlecvi.com	Image post-processing, ventricular function, atrial strain, T1/T2 mapping, and ECV analysis
Dedicated cardiac phased-array surface coil	Siemens Healthineers	www.siemens-healthineers.com	Cardiac imaging surface coil
Gadolinium-based contrast agent (GBCA)	Manufacturer not specified	N/A	Intravenous contrast agent for LGE imaging and post-contrast T1 mapping
IBM SPSS Statistics version 29	IBM	www.ibm.com/products/spss-statistics	Statistical analysis
MAGNETOM Spectra 3.0 T Magnetic Resonance Imaging System	Siemens Healthineers	www.siemens-healthineers.com	3.0 T cardiovascular magnetic resonance scanner
MR-compatible electrocardiography (ECG) gating unit	Siemens Healthineers	www.siemens-healthineers.com	ECG gating during CMR acquisition