A comprehensive multi‐index cardiac magnetic resonance‐guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long‐term outcomes

Autor: John Whitaker, Reza Razavi, Wieland Staab, Mark D O'Neill, James Harrison, Matthew Wright, J. Gill, Rashed Karim, Henry Chubb, Rahul K Mukherjee, Steven Williams, Tobias Schaeffter, Steven A. Niederer
Rok vydání: 2019
Předmět:
Male
Time Factors
medicine.medical_treatment
Action Potentials
030204 cardiovascular system & hematology
Ventricular Function
Left
Pulmonary vein
0302 clinical medicine
Heart Rate
Recurrence
Risk Factors
Fibrosis
catheter ablation
Atrial Fibrillation
atrial fibrillation
030212 general & internal medicine
Ejection fraction
medicine.diagnostic_test
Hazard ratio
Atrial fibrillation
Middle Aged
Treatment Outcome
Pulmonary Veins
Catheter Ablation
cardiovascular system
Cardiology
Atrial Function
Left
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
cardiac magnetic resonance imaging
Diastole
structural remodeling
Magnetic Resonance Imaging
Cine
Catheter ablation
Risk Assessment
03 medical and health sciences
Predictive Value of Tests
Cardiac magnetic resonance imaging
Physiology (medical)
Internal medicine
medicine
Humans
Aged
business.industry
Reproducibility of Results
Stroke Volume
Atrial Remodeling
medicine.disease
atrial fibrosis
business
Zdroj: Chubb, H, Karim, R, Mukherjee, R, Williams, S E, Whitaker, J, Harrison, J, Niederer, S E, Staab, W, Gill, J, Schaeffter, T, Wright, M, O'Neill, M & Razavi, R 2019, ' A comprehensive multi-index cardiac magnetic resonance-guided assessment of atrial fibrillation substrate prior to ablation : prediction of long-term outcomes ', Journal of Cardiovascular Electrophysiology, vol. 30, no. 10, pp. 1894-1903 . https://doi.org/10.1111/jce.14111
ISSN: 1540-8167
1045-3873
DOI: 10.1111/jce.14111
Popis: INTRODUCTION Multiple cardiac magnetic resonance (CMR)-derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long-term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), left ventricular ejection fraction (LVEF), LA shape (sphericity) and pulmonary vein anatomy have all been shown to correlate with late AF recurrence. This study aimed to validate and assess the relative contribution of multiple indices in a long-term single-center study. METHODS AND RESULTS Eighty-nine patients (53% paroxysmal AF, 73% male) underwent comprehensive CMR study before first-time AF ablation (median follow-up 726 days [IQR: 418-1010 days]). The 3D late gadolinium-enhanced acquisition (1.5T, 1.3 × 1.3 × 2 mm) was quantified for fibrosis; LA volume and sphericity were assessed on manual segmentation at atrial diastole; LAEF and LVEF were quantified on multislice cine imaging. AF recurred in 43 patients (48%) overall (31 at 1 year). In the recurrence group, LA fibrosis was higher (42% vs 29%; hazard ratio [HR]: 1.032; P = .002), left atrial ejection fraction (LAEF) lower (25% vs 34%; HR: 0.063; P = .016) and LVEF lower (57% vs 63%; HR: 0.011; P = .008). LA volume (135 vs 124 mL) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (Model 1), additionally AF type (Model 2) and combined (Model 3). In Models 1 and 2, LA fibrosis, LAEF, and LVEF were independently associated with outcome, but only LA fibrosis was independent in Model 3 (HR: 1.021; P = .022). CONCLUSIONS LAEF, LVEF, and LA fibrosis differed significantly in the AF recurrence cohort. However, on combined multivariate analysis only LA fibrosis remained independently associated with outcome.
Databáze: OpenAIRE
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