Advanced cardiac imaging analysis in atrial fibrillation and its hemodynamics
Date
2023-12-20
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Abstract
Atrial fibrillation (AF) is a prevalent cardiac disorder characterized by rapid and disorganized atrial activation, resulting in impaired atrial function. With a global impact affecting approximately 33.5 million individuals, AF leads to an elevated risk of complications such as thromboembolism and stroke. Current treatment guidelines primarily rely on patient demographics and medical history, yet a more precise therapeutic approach based on individual flow is required.
4D flow magnetic resonance imaging (MRI) offers comprehensive measurement of flow velocity throughout the entire cardiac cycle in three dimensions. While previous studies have explored the application of 4D flow techniques in AF, they have encountered limitations related to resolution and contrast, particularly when segmenting the fine structures of the left atrium (LA). Furthermore, the clinical parameters derived from 4D flow MRI in AF have been relatively limited, and there has been notable absence of studies focused on assessing flow recovery after catheter ablation.
This research addresses the technical and clinical gaps in previous studies, aiming to enhance the clinical applicability of 4D flow imaging techniques in AF. In clinical aspect, our investigation explores the impact of AF on left ventricular (LV) flow in paroxysmal AF using LV flow component analysis. This analysis unveils subtle alterations in LV flow efficiency, even in patients with paroxysmal AF and normal systolic function, indicating hemodynamic changes without signs of adverse LV remodeling. Our comparative study of LA flow in AF patients before and after catheter ablation reveals significant changes in LA blood flow stasis using 4D flow imaging. To overcome the limitations of resolution and contrast of 4D flow, we propose a segmentation method utilizing standard-of-care contrast-enhanced magnetic resonance angiography (CE-MRA) and a registration process with 4D flow data.
In conclusion, this thesis advances the application of 4D-flow MRI in AF studies, offering novel insights and clinically relevant findings. These findings pave the way for more precise and individualized therapeutic strategies in the management of AF.
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Keywords
4D flow MRI, atrial fibrillation, magnetic resoance imaging, image processing, cardiovascular, hemodynamics