title: Prognostic Implications of Left Ventricular Scar Determined by Late Gadolinium Enhanced Cardiac Magnetic Resonance in Patients With Atrial Fibrillation.
abstract: 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.
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Promporn
authors.initials: P
authors.lastname: Suksaranjit
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McGann
authors.affiliation: Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah; Division of Cardiology, University of Washington, Seattle, Washington.
authors.forename: Nazem
authors.initials: N
authors.lastname: Akoum
authors.affiliation: Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah.
authors.forename: Joseph
authors.initials: J
authors.lastname: Biskupiak
authors.affiliation: Department of Epidemiology, University of Utah, Salt Lake City, Utah.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.affiliation: Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah; Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah.
authors.forename: Eugene G
authors.initials: EG
authors.lastname: Kholmovski
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Leenhapong
authors.initials: L
authors.lastname: Navaravong
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Allen
authors.initials: A
authors.lastname: Rassa
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Erik
authors.initials: E
authors.lastname: Bieging
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Lowell
authors.initials: L
authors.lastname: Chang
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Imran
authors.initials: I
authors.lastname: Haider
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah.
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Comprehensive Arrhythmia Research & Management Center, Salt Lake City, Utah. Electronic address: brent.wilson@hsc.utah.edu.
authors.forename: Brent D
authors.initials: BD
authors.lastname: Wilson
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D002318:Cardiovascular Diseases / Q000401:mortality; D017115:Catheter Ablation; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003287:Contrast Media; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006333:Heart Failure / Q000453:epidemiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors
chemical_list: D003287:Contrast Media; D005682:Gadolinium