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2017 ; 14
(3
): 185-194
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How to detect atrial fibrosis
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Lacalzada-Almeida J
; García-Niebla J
J Geriatr Cardiol
2017[Mar]; 14
(3
): 185-194
PMID28592962
show ga
In the last twenty years, new imaging techniques to assess atrial function and to
predict the risk of recurrence of atrial fibrillation after treatment have been
developed. The present review deals with the role of these techniques in the
detection of structural and functional changes of the atrium and diagnosis of
atrial remodeling, particularly atrial fibrosis. Echocardiography allows the
detection of anatomical, functional changes and deformation of the atrial wall
during the phases of the cardiac cycle. For this, adequate acquisition of atrial
images is necessary using speckle tracking imaging and interpretation of the
resulting strain and strain rate curves. This allows to predict new-onset atrial
fibrillation and recurrences. Its main limitations are inter-observer
variability, the existence of different software manufacturers, and the fact that
the software used were originally developed for the evaluation of the ventricular
function and are now applied to the atria. Cardiac magnetic resonance, using
contrast enhancement with gadolinium, plays a key role in the visualization and
quantification of atrial fibrosis. This is the established method for in vivo
visualization of myocardial fibrotic tissue. The non-invasive evaluation of
atrial fibrosis is associated with the risk of recurrence of atrial fibrillation
and with electro-anatomical endocardial mapping. We discuss the limitations of
these techniques, derived from the difficulty of demonstrating the correlation
between fibrosis imaging and histology, and poor intra- and inter-observer
reproducibility. The sources of discordance are described, mainly due to image
acquisition and processing, and the challenges ahead in an attempt to eliminate
differences between operators.
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