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Healthy volunteer (n = 41) and familial dilated cardiomyopathy (DCM) (n = 31) cohorts were acquired for normalization and validation, respectively. Fibrosis was quantified using late gadolinium enhancement (LGE)-CMR, and 3D regional strain was quantified using feature tracking. Machine learning classifiers were used to classify regional severe fibrosis (&amp;gt;30% LGE enhancement) using regional strain and global measures of atrial anatomy and function. 3D regional strain measures (peak reservoir strain or first\/second strain principal component) alone were not associated with regional fibrosis (accuracies \u2264 56.0%) in the AF cohort. Severe fibrosis was found primarily in the lateral (85.1% of AF patients) and posterior (66.0%) regions. In AF patients, the classifier incorporating LAV, LAEF, and regional location was associated with severe regional fibrosis (AUC = 0.86 \u00b1 0.06, accuracy = 79.4 \u00b1 6.2%), while in familial DCM patients, the accuracy was lower (62.8%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>There is a distinctive pattern of fibrosis that develops with progression of atrial cardiomyopathy, irrespective of cause. Global measures reflecting overall atrial anatomy (LAV) and function (LAEF), rather than localized regional 3D strain, were associated with severe regional fibrosis. These data suggest that regional atrial 3D strain alone is not a reliable surrogate for severe regional fibrosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyaf068","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T01:20:22Z","timestamp":1748395222000},"source":"Crossref","is-referenced-by-count":2,"title":["Is regional atrial strain a useful surrogate of regional atrial fibrosis in atrial cardiomyopathy?"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2385-6875","authenticated-orcid":false,"given":"Angela W C","family":"Lee","sequence":"first","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, St Thomas\u2019 Hospital , London ,","place":["UK"]},{"name":"National Heart and Lung Institute, Imperial Centre for Translational and Experimental Medicine, Imperial College London, 72 Du Cane Rd, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Sillett","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, St Thomas\u2019 Hospital , London ,","place":["UK"]},{"name":"National Heart and Lung Institute, Imperial Centre for Translational and Experimental Medicine, Imperial College London, 72 Du Cane Rd, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Alonso","family":"Solis-Lemus","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, St Thomas\u2019 Hospital , London ,","place":["UK"]},{"name":"National Heart and Lung Institute, Imperial Centre for Translational and Experimental Medicine, Imperial College London, 72 Du Cane Rd, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassia","family":"Kessler Iglesias","sequence":"additional","affiliation":[{"name":"Victor Chang Cardiac Research Institute , Darlinghurst, New South Wales ,","place":["Australia"]},{"name":"Cardiology Department, St Vincent\u2019s Hospital Sydney , Darlinghurst, New South Wales ,","place":["Australia"]},{"name":"School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney , Kensington, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luuk H G A","family":"Hopman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam University Medical Center , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2648-7326","authenticated-orcid":false,"given":"Alina","family":"Hua","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, St Thomas\u2019 Hospital , London ,","place":["UK"]},{"name":"Cardiology Department, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wheen","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, St Thomas\u2019 Hospital , London ,","place":["UK"]},{"name":"Cardiology Department, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Qayyum","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial Centre for Translational and Experimental Medicine, Imperial College London, 72 Du Cane Rd, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1312-251X","authenticated-orcid":false,"given":"Marina","family":"Strocchi","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial Centre for Translational and Experimental Medicine, Imperial College London, 72 Du Cane Rd, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6809-0928","authenticated-orcid":false,"given":"Caroline","family":"Roney","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, St Thomas\u2019 Hospital , London ,","place":["UK"]},{"name":"School of Engineering and Materials Science, Queen Mary University of London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0984-3998","authenticated-orcid":false,"given":"Thomas","family":"Booth","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, St Thomas\u2019 Hospital , London ,","place":["UK"]},{"name":"Department of Neuroradiology, Kings College Hospital , Ruskin Wing, London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tevfik F","family":"Ismail","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, St Thomas\u2019 Hospital , London ,","place":["UK"]},{"name":"Cardiology Department, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Chubb","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Stanford University , Stanford, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B","family":"Ennis","sequence":"additional","affiliation":[{"name":"Division of Pediatric Radiology and Cardiovascular Imaging, Stanford University , Stanford, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Victor Chang Cardiac Research Institute , Darlinghurst, New South Wales ,","place":["Australia"]},{"name":"Cardiology Department, St Vincent\u2019s Hospital Sydney , Darlinghurst, New South Wales ,","place":["Australia"]},{"name":"School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney , Kensington, New 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