Evaluation of late atrial enhancement by cardiac magnetic resonance imaging in patients with obstructive sleep apnea

Introduction: Atrial fibrillation (AF) is a growing public health problem especially due to its association with thromboembolic phenomena. Among its risk factors, obstructive sleep apnea (OSA) has increased in incidence and is often under diagnosed. OSA increases the risk of AF by mechanisms not fully known, but it may lead to remodeling and structural alteration of the atria. Cardiac magnetic resonance (CMR), in addition to assessing heart morphology, allows the identification of areas of fibrosis, including the atrium, by the late gadolinium enhancement technique (LGE) and could identify cases of OSA with potential atrial instability. Objective: To evaluate the relationship of LGE atrial by CMR in patients with atrial fibrillation with OSA. Methods: We selected 81 patients who were divided into four groups: Group 1: 20 OSA patients without AF, Group 2: 20 OSA and AF patients, Group 3: 21 patients with only atrial fibrillation without OSA and Group 4: 20 healthy patients without associated comorbidities. All underwent CMR for morphofunctional evaluation and LGE research. Results: The average age was 57.1+-10.59 years. Clinical variables such as hypertension (p = 0.24) and Diabetes Mellitus (p = 0.20) were not predictors of AF in OSA patients. Of the 40 cases with OSA, 18, 45% had severe obstructive disorder, and in this group AF was more prevalent. The mean left ventricular ejection fraction was 62.9% (+-7.46) and it did not differ between groups (p = 0.2). Patients with concomitant OSA and AF had significantly larger left atria (p < 0.001). Cases of OSA with AF showed significantly more atrial LGE (95% vs. 30%, p < 0.001), being an independent predictor in multivariate analysis (P < 0,001). Conclusion: Atrial LGE is independently associated with the presence of AF in patients with OSA. These elements may help to identify cases of higher risk for developing AF in OSA patients in clinical practice. (C) 2020 Elsevier B.V. All rights reserved.