OCR Text |
Show 229 THE UNIVERSITY OF UTAH Atrial fibrillation (AF), the most common cardiac arrhythmia and a leading cause of stroke, is sustained by structural remodeling (SRM), or tissue changes,, or remodel in tissues of the left atrium (LA). Late Gadolinium-Enhancement Magnetic Resonance Imaging (LGE-MRI) can non-invasively detect visualize remodeling in the LA, allowing for the extent of these structural changes to be quantified. Physicians may then personalize treatments and triage patients based on the extent of structural remodelingLA-SRM. While past studies have focused on the severity of structural remodelingLA-SRM across demographics such as age and gender, changes in LA structure relative to population density have yet to be explored. The U.S. De-partment of Commerce (USDOC) reports that the prevalence and distribution of AF patients, residing in both rural and urban locations, shows a majority of admissions and diagnosis of AF to be in urban hospital locations. Thus, we hypothesize that the population density in which a patient lives may impacts the extent of LA structural remodelingLA-SRM. In this study, we aim to define residential areas according to the U.S. Department of CommerceUSDOC criteria and categorize patients into groups based on extent of structural remodelingLA-SRM using the Utah Classification of Left Atrial Structural Remodeling. By using the U.S. Decennial Census of 2000 in a series of selecting 5-digit and 3-digit ZIP Code Tabulation Area Codes, the popu-lation of the area in which the patient resides facilitatedwas filtered to present geographic categorization of urban and rural populations. Surrounding areas to these ZIP codes and boundaries with multiple ZIP codes were taken into consideration and properly filtered by the given criteria to present urban and rural populations. LGE-MRIs were acquired from patients using either a 1.5-T Avanto or 3-T Verio clinical scanner (Siemens Medical Solutions, Erlangen, Germany) using a total imaging matrix phased-array receiver coil.using Aan ECG 3-D- gated and respiration-ory navigated 3D sequence [Figure A].can was taken of the LA during atrial diastole phase for each patient. Epicardial and endocardial LA borders of the LGE-MRI scan were manually contoured with image display and analysis software in Corview (Marrek, Inc., Salt Lake City, Utah) [Figure B]. The extent of contrast enhancement (LA-SRM) relative to the LA wall was visualized as a 3D surface rendering [Figure C] and quantified as a percentage. A total of 823 patients were included in the study, with 105 residing in rural areas (12.7%) and a vast majority (87.3%) in urban settings. The mean LA-SRM between patients from rural (16.4+/- 8.3%) and urban areas (16.0+/-10.0%) was not significantly different from each other (P= 0.35). A logistic regression indicated absence of any relationship between population density (urban versus rural) and LA-SRM (P=0.13). IMPACT OF POPULATION DENSITY OF LEFT ATRIAL REMODELING IN PATIENTS WITH ATRIAL FIBRILLATION Alexander Au (Nassir Marrouche) Department of Cardiology, CARMA Center University of Utah honors college Alexander Au Nassir Marrouche |