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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

CMR-derived left atrial reservoir strain and the LAVI/LVEF ratio are associated with 30-day readmission in atrial fibrillation: the CMRRADAR-AF retrospective cohort study

  • Maethas Panyawongkhanti1,2
  • Anuchai Fueangtalop3
  • Nattanon Satitthammaphon2
  • Chokanan Thaitirarot4
  • Viroj Mueangsilpsat2
  • Chanwit Wuttichaipradit2,3
  • Anusith Tunhasiriwer2
  • Chonthicha Tanking2
4 affiliations
  1. 1Princess Srisavangavadhana Faculty of Medicine, Chulabhorn Royal Academy
  2. 2Department of Cardiovascular Medicine, Chulabhorn Hospital
  3. 3Department of Radiology, Chulabhorn Hospital
  4. 4Department of Cardiology, Chulabhorn Hospital
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Abstract

Background: Cardiovascular magnetic resonance (CMR) imaging allows simultaneous evaluation of cardiac structure, function, and tissue composition. Whether CMR-derived left atrial (LA) reservoir strain, the left atrial volume index–left ventricular ejection fraction (LAVI/LVEF) ratio, and atrial late gadolinium enhancement (LGE) can identify patients at risk for 30-day readmission after atrial fibrillation (AF)–related hospitalisation has not been investigated.

Objectives: This study aims to evaluate the association between CMR parameters and 30-day unplanned readmission following an AF-related index admission and to describe CMR differences across three clinical groups using a three-group cohort design.

Methods: This retrospective cohort study at Chulabhorn Hospital, Bangkok (IRB005/2569), enrolled 43 patients with AF who underwent CMR on 1.5 T or 3 T Philips scanners: 25 outpatients (OPD), 10 index-admitted patients without readmission (Adm-NoReadmit), and 8 index-admitted patients with 30-day unplanned readmission (Readmit). A CMR analysis was performed using CVI42 version 6.4. LA reservoir strain was derived by feature tracking from standard cine images.

Results: Among the admitted patients ( n = 18), LA reservoir strain showed the highest apparent discrimination for readmission [area under the curve (AUC), 0.963; p < 0.001; exploratory internally derived cutpoint <11.1%: sensitivity, 88%; 95% confidence interval (CI), 47%–100%; specificity, 100%; 95% CI, 69%–100%]. Correcting for predictor selection, the optimism-corrected AUC was 0.919. The LAVI/LVEF ratio was also associated with readmission (AUC, 0.913; p = 0.002). Qualitative atrial hyperenhancement on non-dedicated LGE imaging completely separated readmitted from non-readmitted admitted patients (8/8 vs. 0/10); however, because it was assessed on an LV-optimised protocol not validated for atrial tissue, we report it only as an exploratory qualitative finding and do not interpret it as evidence of a fibrosis mechanism. The LACE score (length of stay, acuity of admission, Charlson comorbidity index, and emergency department visits) achieved an AUC of 0.719 (95% CI, 0.44–0.95; p = 0.125); an exploratory combined LACE+ LA reservoir strain model produced a numerically higher apparent AUC, but with only eight events, this estimate is unstable and likely overfitted and is not interpreted as evidence of incremental value. A three-group analysis revealed a non-monotonic pattern: The Adm-NoReadmit patient group had the highest LA reservoir strain (15.4%), exceeding the OPD group (8.5%), whereas the Readmit group had the lowest (6.6%).

Conclusion: In this exploratory feasibility analysis, CMR-derived LA reservoir strain and the LAVI/LVEF ratio were associated with 30-day unplanned readmission following an AF-related index admission. Because readmitted patients had a substantially higher prevalence of heart-failure history, these associations may reflect a shared structural–functional substrate rather than independent, AF-specific effects. Descriptive comparison across the three clinical groups showed a non-monotonic LA functional pattern, suggesting that CMR may aid risk stratification at discharge. However, prospective validation is needed.

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Cite

BibTeXRIS
BibTeX
@article{panyawongkhanti2026cmrderived,
  title = {{CMR-derived left atrial reservoir strain and the LAVI/LVEF ratio are associated with 30-day readmission in atrial fibrillation: the CMRRADAR-AF retrospective cohort study}},
  author = {Maethas Panyawongkhanti and Anuchai Fueangtalop and Nattanon Satitthammaphon and Chokanan Thaitirarot and Viroj Mueangsilpsat and Chanwit Wuttichaipradit and Anusith Tunhasiriwer and Chonthicha Tanking},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1845659},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1845659/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - CMR-derived left atrial reservoir strain and the LAVI/LVEF ratio are associated with 30-day readmission in atrial fibrillation: the CMRRADAR-AF retrospective cohort study
AU  - Maethas Panyawongkhanti
AU  - Anuchai Fueangtalop
AU  - Nattanon Satitthammaphon
AU  - Chokanan Thaitirarot
AU  - Viroj Mueangsilpsat
AU  - Chanwit Wuttichaipradit
AU  - Anusith Tunhasiriwer
AU  - Chonthicha Tanking
PY  - 2026
DA  - 2026/10/20
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1845659
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1845659/full
AB  - Background: Cardiovascular magnetic resonance (CMR) imaging allows simultaneous evaluation of cardiac structure, function, and tissue composition. Whether CMR-derived left atrial (LA) reservoir strain, the left atrial volume index–left ventricular ejection fraction (LAVI/LVEF) ratio, and atrial late gadolinium enhancement (LGE) can identify patients at risk for 30-day readmission after atrial fibrillation (AF)–related hospitalisation has not been investigated.  Objectives: This study aims to evaluate the association between CMR parameters and 30-day unplanned readmission following an AF-related index admission and to describe CMR differences across three clinical groups using a three-group cohort design.  Methods: This retrospective cohort study at Chulabhorn Hospital, Bangkok (IRB005/2569), enrolled 43 patients with AF who underwent CMR on 1.5 T or 3 T Philips scanners: 25 outpatients (OPD), 10 index-admitted patients without readmission (Adm-NoReadmit), and 8 index-admitted patients with 30-day unplanned readmission (Readmit). A CMR analysis was performed using CVI42 version 6.4. LA reservoir strain was derived by feature tracking from standard cine images.  Results: Among the admitted patients ( n = 18), LA reservoir strain showed the highest apparent discrimination for readmission [area under the curve (AUC), 0.963; p < 0.001; exploratory internally derived cutpoint <11.1%: sensitivity, 88%; 95% confidence interval (CI), 47%–100%; specificity, 100%; 95% CI, 69%–100%]. Correcting for predictor selection, the optimism-corrected AUC was 0.919. The LAVI/LVEF ratio was also associated with readmission (AUC, 0.913; p = 0.002). Qualitative atrial hyperenhancement on non-dedicated LGE imaging completely separated readmitted from non-readmitted admitted patients (8/8 vs. 0/10); however, because it was assessed on an LV-optimised protocol not validated for atrial tissue, we report it only as an exploratory qualitative finding and do not interpret it as evidence of a fibrosis mechanism. The LACE score (length of stay, acuity of admission, Charlson comorbidity index, and emergency department visits) achieved an AUC of 0.719 (95% CI, 0.44–0.95; p = 0.125); an exploratory combined LACE+ LA reservoir strain model produced a numerically higher apparent AUC, but with only eight events, this estimate is unstable and likely overfitted and is not interpreted as evidence of incremental value. A three-group analysis revealed a non-monotonic pattern: The Adm-NoReadmit patient group had the highest LA reservoir strain (15.4%), exceeding the OPD group (8.5%), whereas the Readmit group had the lowest (6.6%).  Conclusion: In this exploratory feasibility analysis, CMR-derived LA reservoir strain and the LAVI/LVEF ratio were associated with 30-day unplanned readmission following an AF-related index admission. Because readmitted patients had a substantially higher prevalence of heart-failure history, these associations may reflect a shared structural–functional substrate rather than independent, AF-specific effects. Descriptive comparison across the three clinical groups showed a non-monotonic LA functional pattern, suggesting that CMR may aid risk stratification at discharge. However, prospective validation is needed.
SN  - 2297-055X
ER  -