ABC | Volume 112, Nº4, April 2019

Original Article Ciuffo et al LA Remodeling and Dyssynchrony Arq Bras Cardiol. 2019; 112(4):441-450 Discussion The main findings are summarized as follows: 1) LA intra-atrial dyssynchrony was independently associated with LA‑LGE, 2) LA intra-atrial dyssynchrony was significantly greater in patients with persistent AF than in those with paroxysmal AF, 3) LA intra-atrial dyssynchrony is a reproducible index, and 4) LA intra-atrial dyssynchrony analysis is less time‑consuming than LA-LGE. LA-LGE and dyssynchrony Our multivariable analysis showed that LA intra-atrial dyssynchrony is associated with LA-LGE after adjusting for clinical risk factors including the AF type. This finding serves as evidence to the potential use of LA intra-atrial dyssynchrony as a surrogate for LA-LGE. In addition, our analysis showed that patients with persistent AF had significantly greater LA intra‑atrial dyssynchrony than those with paroxysmal AF. In contrast, there Figure 3 – Left atrial (LA) late gadolinium enhancement cardiac magnetic resonance (CMR).A– B: anterior LAshell view with areas of enhancement (red). C – D: posterior LA shell view with areas of enhancement (red). E - F: quantification of LA enhancement by CMR using image intensity ratio (IIR). Left side (A, C, and E), individual with low enhancement – right side (B, D, and F), individual with high enhancement. Figure 4 – Association between left atrial (LA) intra-atrial dyssynchrony and LA late gadolinium enhancement (LA-LGE). A, regression between LA-LGE and the standard deviation of the time to peak strain (SD-TPS); B, regression between LA-LGE and the standard deviation of the time to peak pre-atrial strain (SD-TPS preA ). Blue line, linear regression line. Log: logarithmically transformed variables; SD: standard deviation. Log Fibrosis (%) Log SD–TPS (%) Log SD–TPS preA (%) 4 3 2 1 0 0 .5 1 2 1.5 2.5 0 1 3 2 4 –1 4 3 2 1 0 –1 446