Prognostic Implications of Left Ventricular Scar Determined by Late Gadolinium Enhanced Cardiac Magnetic Resonance in Patients With Atrial Fibrillation

Autor: Nazem Akoum, Brent D. Wilson, Imran Haider, Allen Rassa, Lowell Chang, Christopher J. McGann, Eugene G. Kholmovski, Gregory J. Stoddard, Leenhapong Navaravong, Erik Bieging, Promporn Suksaranjit, Nassir F. Marrouche, Joseph Biskupiak
Rok vydání: 2016
Předmět:
Male
Time Factors
Radiofrequency ablation
medicine.medical_treatment
Myocardial Infarction
Contrast Media
Gadolinium
030204 cardiovascular system & hematology
law.invention
Coronary artery disease
0302 clinical medicine
Risk Factors
law
Atrial Fibrillation
Odds Ratio
Medicine
030212 general & internal medicine
Myocardial infarction
Ejection fraction
Smoking
Hazard ratio
Atrial fibrillation
Dilated cardiomyopathy
Middle Aged
Prognosis
Magnetic Resonance Imaging
Stroke
Cardiovascular Diseases
Ischemic Attack
Transient
Catheter Ablation
Cardiology
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Heart Ventricles
Magnetic Resonance Imaging
Cine
Catheter ablation
Cicatrix
03 medical and health sciences
Imaging
Three-Dimensional
Internal medicine
Diabetes Mellitus
Humans
cardiovascular diseases
Aged
Dyslipidemias
Proportional Hazards Models
Retrospective Studies
Heart Failure
business.industry
medicine.disease
Logistic Models
business
Follow-Up Studies
Zdroj: The American Journal of Cardiology. 118:991-997
ISSN: 0002-9149
Popis: Left ventricular (LV) scar identified by late gadolinium enhanced (LGE) cardiac magnetic resonance (CMR) is associated with adverse outcomes in coronary artery disease and cardiomyopathies. We sought to determine the prognostic significance of LV-LGE in atrial fibrillation (AF). We studied 778 consecutive patients referred for radiofrequency ablation of AF who underwent CMR. Patients with coronary artery disease, previous myocardial infarction, or hypertrophic or dilated cardiomyopathy were excluded. The end points of interest were major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiovascular death, myocardial infarction, and ischemic stroke/transient ischemic attack. Of the 754 patients who met the inclusion criteria, 60% were men with an average age of 64 years. Most (87%) had a normal LV ejection fraction of ≥55%. LV-LGE was found in 46 patients (6%). There were 32 MACCE over the mean follow-up period of 55 months. The MACCE rate was higher for patients with LV-LGE (13.0% vs 3.7%; p = 0.002). In multivariate analysis, CHA2DS2-VASc score (hazard ratio [HR] 1.36, 95% CI 1.05 to 1.76), the presence of LV-LGE (HR 3.21, 95% CI 1.31 to 7.88), and the LV-LGE extent (HR 1.43, 95% CI 1.15 to 1.78) were independent predictors of MACCE. In addition, the presence of LV-LGE was an independent predictor for ischemic stroke/transient ischemic attack (HR 3.61, 95% CI 1.18 to 11.01) after adjusting for CHA2DS2-VASc score. In conclusion, the presence and extent of LV scar identified by LGE-CMR were independent predictors of MACCE in patients with AF.
Databáze: OpenAIRE
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