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

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• 作者：Promporn Suksaranjit ; MD ; MS^a ; ^b ; Christopher J. McGann ; MD^a ; ^b ; Nazem Akoum ; MD ; MS^b ; ^c ; Joseph Biskupiak ; PhD ; MBA^d ; Gregory J. Stoddard ; MS^e ; Eugene G. Kholmovski ; PhD^b ; ^f ; Leenhapong Navaravong ; MD^a ; Allen Rassa ; MD^a ; Erik Bieging ; MD^a ; ^b ; Lowell Chang ; MD^a ; ^b ; Imran Haider ; MD^a ; ^b ; Nassir F. Marrouche ; MD^a ; ^b ; Brent D. Wilson ; MD ; PhD^a ; ^b ; ^{brent.wilson@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author}
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：1 October 2016
• 年：2016
• 卷：118
• 期：7
• 页码：991-997
• 全文大小：712 K

文摘

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.