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April 26, 2026Korean Journal of RadiologyOpen Access

TR-MRA-derived left atrial time-to-peak was independently associated with invasively measured left atrial pressure and identified high pressure with an AUC of 0.834.

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Why the study?

To evaluate TR-MRA-derived left atrial time-to-peak as a noninvasive indicator of left atrial pressure in patients with AF.

Does TR-MRA-derived left atrial time-to-peak accurately identify high left atrial pressure in patients with atrial fibrillation undergoing catheter ablation?

Population

92 patients undergoing cardiac TR-MRA and catheter-based LAP measurement before AF catheter ablation

Comparison

TR-MRA-derived left atrial TTP vs catheter-based LAP reference standard

Design

Retrospective study

Key result

TR-MRA-derived left atrial time-to-peak was independently associated with invasively measured left atrial pressure and identified high pressure with an AUC of 0.834.

Authors

JSJ ShimSPSoojung ParkYOYu-Whan Oh

Discussion

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Overview

Hypothesis-generating for noninvasive LAP assessment with TR-MRA TTP in AF; prospective validation needed before clinical adoption.

Key Points

  • This study aims to assess the effectiveness of left atrial time-to-peak from MR angiography as an indicator of left atrial pressure in atrial fibrillation patients.
  • Retrospective analysis of 92 patients undergoing cardiac MR angiography and catheter-based LAP measurements.
  • Time-to-peak was derived from contrast-enhanced time-signal intensity curves.
  • Univariable and multivariable linear regression analyses were conducted with LAP as the dependent variable.
  • Mean time-to-peak was significantly longer in patients with high LAP compared to low LAP (25.1 s vs. 16.9 s, P < 0.001).
  • TTP remained independently associated with LAP (β = 0.46, P < 0.001).
  • ROC analysis showed an area under the curve of 0.834 for TTP in identifying high LAP.

Study Design

Type

Observational (n=92)

Multicenter

No

Structured PICO

Does TR-MRA-derived left atrial time-to-peak accurately identify high left atrial pressure in patients with atrial fibrillation undergoing catheter ablation?

P
Population
92 patients who underwent cardiac TR-MRA and catheter-based LAP measurements prior to catheter ablation for atrial fibrillation (AF) between January 2021 and December 2022. Mean age 60 ± 10 years, 70 (76.0%) male. Inclusion criteria: TR-MRA during sinus rhythm, catheter-based LAP measurement within one day after TR-MRA.
I
Intervention
Left atrial time-to-peak (TTP) derived from time-resolved magnetic resonance angiography (TR-MRA)
C
Comparator
Invasively measured left atrial pressure (LAP) via catheterization (reference standard)
O
Outcome
Diagnostic performance of TTP for identifying high LAP (≥15 mmHg)surrogate

Main Result

Effect estimate: AUC 0.834 (95% CI 0.742-0.904)

p-value: p=<0.001

TR-MRA-derived left atrial time-to-peak is a reliable noninvasive imaging marker that independently correlates with invasively measured left atrial pressure in patients with atrial fibrillation.

Limitations

  • Retrospective, single-center design
  • Inclusion of only patients who underwent TR-MRA during sinus rhythm
  • Relatively small sample size
  • Use of a single ROI
  • Limited number of patients with high LAP
  • Residual confounding factors related to complex left atrial hemodynamics
  • Did not assess the prognostic implications of TR-MRA-derived TTP after catheter ablation
  • Relatively small sample size and limited number of patients with high LAP
  • Cross-sectional design without prognostic assessment

Cite This Study

Shim et al. (2026) conducted an observational in Atrial fibrillation (n=92). Time-resolved magnetic resonance angiography (TR-MRA) derived time-to-peak (TTP) vs. Invasive catheter-based left atrial pressure (LAP) measurement was evaluated on Identification of high left atrial pressure (≥15 mmHg) (AUC 0.834, 95% CI 0.742-0.904, p=<0.001). TR-MRA-derived left atrial time-to-peak was independently associated with invasively measured left atrial pressure and identified high pressure with an AUC of 0.834.

synapsesocial.com/papers/69edac9b4a46254e215b45dchttps://doi.org/10.3348/kjr.2025.1622
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