Association between left atrial function and pulmonary vein stump thrombus after left upper lobectomy: insights from cine-MRI

The purpose of this study is to evaluate left atrial function using cine-magnetic resonance imaging (cine-MRI) in patients with pulmonary vein stump thrombus (PVST) after left upper lobectomy (LUL). The study population comprised 91 patients (30 with PVST and 61 without PVST) who underwent LUL for pulmonary lesions and evaluation by cine-MRI. Left atrial functional parameters were evaluated and compared between patients with and without the development of PVST after LUL using the Mann-Whitney U test. The diagnostic capabilities of these parameters for predicting PVST development were assessed using receiver-operating characteristic (ROC) curve analysis. Clinical and left atrial functional parameters were analyzed by multivariate logistic regression models to determine predictors of PVST. Left atrial end-systolic volume (LAESV), left atrial end-diastolic volume (LAEDV), LAESV index (LAESVI), and LAEDV index (LAEDVI) were significantly greater in patients who developed PVST than in those without PVST (p = 0.009, < 0.001, 0.004, and < 0.001, respectively). Left atrial ejection fraction (LAEF) was significantly lower in patients who developed PVST than in those without PVST (p < 0.001). The area under the ROC curve for predicting PVST was 0.668, 0.769, 0.688, 0.792, and 0.803 for LAESV, LAEDV, LAESVI, LAEDVI, and LAEF, respectively. In the multivariate logistic regression analysis, only LAEF was identified as an independent predictor of PVST (OR 0.896; 95% CI 0.846-0.950). In conclusion, left atrial enlargement and left atrial dysfunction were associated with the development of PVST after LUL.