Magnetic resonance imaging based assessment of cardiac remodelling and tissue characteristics as predictor of atrial fibrillation in patients with moderate to severe rheumatic mitral valve disease.

We report association of indices of cardiac remodeling and fibrosis on magnetic resonance imaging (MRI) with atrial fibrillation (AF) in patients with moderate to severe rheumatic mitral valve disease. Sixty consecutive patients of RHD with moderate to severe mitral valve dysfunction: 30 with atrial fibrillation and 30 age and sex matched without atrial fibrillation were enrolled as cases and controls respectively. The left atrial (LA) volume, left ventricular (LV) volumes and ejection fraction were calculated using MRI. The association of clinical and MRI parameters with atrial fibrillation was estimated by calculating Odds ratio with 95% C.I. using multivariate logistic regression model. The LA volume (211.23 ± 45.50 ml vs. 129.7 ± 45.8 ml; p < 0.005) was significantly higher in patients with atrial fibrillation. The LVEF (46.8 ± 10.2% vs. 55.9 ± 15.0%; p < 0.008) and RVEF (39.9 ± 9.4% vs. 46.8 ± 14.2%; p < 0.03) were significantly lower in patients with atrial fibrillation. The LA fibrosis was significantly higher in patients with atrial fibrillation (93.34% vs. 26.67% p < 0.001). Age, LA volume, LV and RV ejection fraction had no significant association after adjustment of effect of LA fibrosis. LA fibrosis had significant and independent association with atrial fibrillation (Odds ratio 25.9, 95% C.I. 4.2, 158.3; p < 0.001). LA fibrosis was the lone risk factor associated with atrial fibrillation in patients with RHD with moderate to severe mitral valve dysfunction. Role of LA fibrosis in prediction of atrial fibrillation may have potential role in risk stratification in patients with normal sinus rhythm.