Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/201837
Type: Artigo de periódico
Title: Myocardial Extracellular Volume Expansion And The Risk Of Recurrent Atrial Fibrillation After Pulmonary Vein Isolation.
Author: Neilan, Tomas G
Mongeon, Francois-Pierre
Shah, Ravi V
Coelho-Filho, Otavio
Abbasi, Siddique A
Dodson, John A
McMullan, Ciaran J
Heydari, Bobak
Michaud, Gregory F
John, Roy M
Blankstein, Ron
Jerosch-Herold, Michael
Kwong, Raymond Y
Abstract: This study tested whether myocardial extracellular volume (ECV) is increased in patients with hypertension and atrial fibrillation (AF) undergoing pulmonary vein isolation and whether there is an association between ECV and post-procedural recurrence of AF. Hypertension is associated with myocardial fibrosis, an increase in ECV, and AF. Data linking these findings are limited. T1 measurements pre-contrast and post-contrast in a cardiac magnetic resonance (CMR) study provide a method for quantification of ECV. Consecutive patients with hypertension and recurrent AF referred for pulmonary vein isolation underwent a contrast CMR study with measurement of ECV and were followed up prospectively for a median of 18 months. The endpoint of interest was late recurrence of AF. Patients had elevated left ventricular (LV) volumes, LV mass, left atrial volumes, and increased ECV (patients with AF, 0.34 ± 0.03; healthy control patients, 0.29 ± 0.03; p < 0.001). There were positive associations between ECV and left atrial volume (r = 0.46, p < 0.01) and LV mass and a negative association between ECV and diastolic function (early mitral annular relaxation [E'], r = -0.55, p < 0.001). In the best overall multivariable model, ECV was the strongest predictor of the primary outcome of recurrent AF (hazard ratio: 1.29; 95% confidence interval: 1.15 to 1.44; p < 0.0001) and the secondary composite outcome of recurrent AF, heart failure admission, and death (hazard ratio: 1.35; 95% confidence interval: 1.21 to 1.51; p < 0.0001). Each 10% increase in ECV was associated with a 29% increased risk of recurrent AF. In patients with AF and hypertension, expansion of ECV is associated with diastolic function and left atrial remodeling and is a strong independent predictor of recurrent AF post-pulmonary vein isolation.
Subject: Adult
Aged
Aged, 80 And Over
Atrial Fibrillation
Cardiac Volume
Cardiomyopathies
Catheter Ablation
Disease Progression
Echocardiography, Doppler
Electrocardiography
Extracellular Space
Female
Fibrosis
Follow-up Studies
Heart Atria
Humans
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardium
Pilot Projects
Prospective Studies
Pulmonary Veins
Recurrence
Af
Ci
Cmr
Ecg
Ecv
Hr
Htn
La
Lge
Lv
Pvi
T(1) Measurements
Atrial Fibrillation
Cardiac Magnetic Resonance
Confidence Interval
Electrocardiography
Extracellular Volume
Hazard Ratio
Hypertension
Late Gadolinium Enhancement
Left Atrial
Left Ventricular
Myocardial Fibrosis
Pulmonary Vein Isolation
Rights: fechado
Identifier DOI: 10.1016/j.jcmg.2013.08.013
Address: http://www.ncbi.nlm.nih.gov/pubmed/24290570
Date Issue: 2014
Appears in Collections:Unicamp - Artigos e Outros Documentos

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