Artículos de revistas
The Incidence, Pattern, and Prognostic Value of Left Ventricular Myocardial Scar by Late Gadolinium Enhancement in Patients With Atrial Fibrillation
Registro en:
Journal Of The American College Of Cardiology. Elsevier Science Inc, v. 62, n. 23, n. 2205, n. 2214, 2013.
0735-1097
1558-3597
WOS:000328073000010
10.1016/j.jacc.2013.07.067
Autor
Neilan, TG
Shah, RV
Abbasi, SA
Farhad, H
Groarke, JD
Dodson, JA
Coelho, O
McMullan, CJ
Heydari, B
Michaud, GF
John, RM
van der Geest, R
Steigner, ML
Blankstein, R
Jerosch-Herold, M
Kwong, RY
Institución
Resumen
Objectives This study sought to identify the frequency, pattern, and prognostic significance of left ventricular (LV) late gadolinium enhancement (LGE) in patients with atrial fibrillation (AF). Background There are limited data on the presence, pattern, and prognostic significance of LV myocardial fibrosis in patients with AF. LGE during cardiac magnetic resonance imaging is a marker for myocardial fibrosis. Methods A group of 664 consecutive patients without known prior myocardial infarction who were referred for radiofrequency ablation of AF were studied. Cardiac magnetic resonance imaging was requested to assess pulmonary venous anatomy. Results Overall, 73% were men, with a mean age of 56 years and a mean LV ejection fraction of 56 +/- 10%. LV LGE was found in 88 patients (13%). The endpoint was all-cause mortality, and in this cohort, 68 deaths were observed over a median follow-up period of 42 months. On univariate analysis, age (hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 1.03 to 1.08; chi-square likelihood ratio [LR chi(2)]: 15.2; p = 0.0001), diabetes (HR: 2.39; 95% CI: 1.41 to 4.09; LR chi(2): 10.3; p = 0.001), a history of heart failure (HR: 1.78; 95% CI: 1.09 to 2.91; LR chi(2) 2: 5.37; p = 0.02), left atrial dimension (HR: 1.04; 95% CI: 1.01 to 1.08; LR chi(2) 2: 6.47; p = 0.01), presence of LGE (HR: 5.08; 95% CI: 3.08 to 8.36; LR chi(2):28.8; p < 0.0001), and LGE extent (HR: 1.15; 95% CI: 1.10 to 1.21; LR chi(2): 35.6; p < 0.0001) provided the strongest associations with mortality. The mortality rate was 8.1% per patient-year in patients with LGE compared with 2.3% patients without LGE. In the best overall multivariate model for mortality, age and the extent of LGE were independent predictors of mortality. Indeed, each 1% increase in the extent of LGE was associated with a 15% increased risk for death. Conclusions In patients with AF, LV LGE is a frequent finding and is a powerful predictor of mortality. (C) 2013 by the American College of Cardiology Foundation 62 23 2205 2214 American Heart Association Fellow to Faculty Grant [12FTF12060588] NIH National Institutes of Health [RO1HL090634, RO1HL091157] American Heart Association Fellow to Faculty Grant [12FTF12060588] National Institutes of Health [RO1HL090634, RO1HL091157]