Atrial fibrillation (AF), which is associated with fibrosis formation within the left atrial (LA) myocardium, induces haemodynamic changes in the LA cavity which increases the risk of thrombi development and subsequent stroke. Computational fluid dynamics (CFD) can be used to analyse LA flow in high spatial and temporal resolution. Late gadolinium enhancement (LGE) is an MRI technique used to evaluate the extent of fibrosis in the myocardium. Here we analyse 16 patients with a dynamic LA CFD model where patient-specific geometries are derived from CT. 4D flow MRI provides the inlet flows and LA wall motion for the model. We then compare the haemodynamics with the spatial distribution of fibrosis from LGE data. The results show that on a global level, greater fibrotic burden is correlated with decreased time-averaged wall shear stress (TAWSS, p = 0.045), increased relative residence time (RRT, p = 0.003) and endothelial cell activation potential (ECAP, p = 0.001). These results suggest that atrial wall fibrosis infiltration and extent in AF is associated with disturbed blood flow haemodynamics.

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Global Left Atrial Wall Fibrosis is Associated with Pro-thrombotic Haemodynamics in Atrial Fibrillation: A Computational Fluid Dynamics Study

  • Louis Parker,
  • Emilie Bollache,
  • Jonas Leite,
  • Shannon Soulez,
  • Khaoula Bouazizi-Verdier,
  • Nicolas Badenco,
  • Estelle Gandjbakhch,
  • Alban Redheuil,
  • Mikael Laredo,
  • Nadjia Kachenoura

摘要

Atrial fibrillation (AF), which is associated with fibrosis formation within the left atrial (LA) myocardium, induces haemodynamic changes in the LA cavity which increases the risk of thrombi development and subsequent stroke. Computational fluid dynamics (CFD) can be used to analyse LA flow in high spatial and temporal resolution. Late gadolinium enhancement (LGE) is an MRI technique used to evaluate the extent of fibrosis in the myocardium. Here we analyse 16 patients with a dynamic LA CFD model where patient-specific geometries are derived from CT. 4D flow MRI provides the inlet flows and LA wall motion for the model. We then compare the haemodynamics with the spatial distribution of fibrosis from LGE data. The results show that on a global level, greater fibrotic burden is correlated with decreased time-averaged wall shear stress (TAWSS, p = 0.045), increased relative residence time (RRT, p = 0.003) and endothelial cell activation potential (ECAP, p = 0.001). These results suggest that atrial wall fibrosis infiltration and extent in AF is associated with disturbed blood flow haemodynamics.