Left atrial volume in the postoperative right-sided malformations of congenital heart diseases assessed by cardiovascular magnetic resonance
Objective:To assess the left atrial volume in patients with postoperative right-sided congenital heart diseases (CHD) with different methods by cardiovasculav magnetic resonance (CMR) and explore the feasibility of biplane area length method.Methods:This study was prospective study. From June 2022 to August 2022, 33 postoperative patients with right-sided CHD who underwent CMR in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine were selected.Left atrial volume indexes, including maximum (LAVImax), minimum (LAVImin) and pre-atrial contraction volume index (LAVIpreA), were obtained by the biplane area-length method and short axis method using Qmass 8.2 software. Then the volume ejection fractions (EF) including reservoir, conduit and pump EF were calculated. The agreement and reproducibility were evaluated between two methods,and the impact of age and gender on volume were explored.Results:All volume parameters had a high correlation between two methods(r 0.77-0.96, P< 0.001). LAVImin of the biplane area-length method was lower than that of the standard short-axis method [12.24(10.17, 3.78) ml/m2 vs. 12.81(10.76, 14.17) ml/m2, P = 0.002], and reservoir and conduit EF were higher than those of the short-axis method [(58.54±7.41)% vs. (56.18±7.19)%, P < 0.001; (36.85±9.41)% vs. (34.78±8.51)%, P = 0.033]. The remaining parameters were not statistically different. The biplane area-length method was significantly faster than the standard short-axis method [(5.67±0.92)min vs.(11.70±1.72)min, P<0.001]. The intraobserver and interobserver reproducibility of left atrial volume parameters by the biplane area-length method was good (intraclass correlation coefficient = 0.85-0.99). Compared with the controls, the patients showed lower reservoir and conduit EF [(58.54±7.41)% vs. (65.46±5.35)%, P < 0.001; (36.85±9.41)% vs. (51.82±12.99)%, P < 0.001], but higher pump EF [(34.39±8.60)% vs. (28.40±11.42)%,P=0.043] with no difference in left atrial volume indexes.Conclusion:The biplane area-length method can be used as an alternative way for the short-axis method with accuracy and efficiency. Left atrial EF have altered before left atrial enlargement, acting as early markers of atrial dysfunction.
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