title: The incidence, pattern, and prognostic value of left ventricular myocardial scar by late gadolinium enhancement in patients with atrial fibrillation .
abstract: OBJECTIVE
  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 [LRχ(2)]: 15.2; p = 0.0001), diabetes (HR: 2.39; 95% CI: 1.41 to 4.09; LRχ(2): 10.3; p = 0.001), a history of heart failure (HR: 1.78; 95% CI: 1.09 to 2.91; LRχ(2): 5.37; p = 0.02), left atrial dimension (HR: 1.04; 95% CI: 1.01 to 1.08; LRχ(2): 6.47; p = 0.01), presence of LGE (HR: 5.08; 95% CI: 3.08 to 8.36; LRχ(2): 28.8; p < 0.0001), and LGE extent (HR: 1.15; 95% CI: 1.10 to 1.21; LRχ(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.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Neilan
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.forename: Siddique A
authors.initials: SA
authors.lastname: Abbasi
authors.forename: Hoshang
authors.initials: H
authors.lastname: Farhad
authors.forename: John D
authors.initials: JD
authors.lastname: Groarke
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.forename: Otavio
authors.initials: O
authors.lastname: Coelho-Filho
authors.forename: Ciaran J
authors.initials: CJ
authors.lastname: McMullan
authors.forename: Bobak
authors.initials: B
authors.lastname: Heydari
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
authors.forename: Rob
authors.initials: R
authors.lastname: van der Geest
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steigner
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation; D002921:Cicatrix / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: AF; CI; CMR; CT; ECG; EF; HR; LGE; LRχ(2); LV; MI; atrial fibrillation; cardiac magnetic resonance; chi-square likelihood ratio; computed tomography; confidence interval; ejection fraction; electrocardiography; hazard ratio; late gadolinium enhancement; late gadolinium enhancement; left ventricular; myocardial infarction