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Type: Artigo de periódico
Title: The Incidence, Pattern, and Prognostic Value of Left Ventricular Myocardial Scar by Late Gadolinium Enhancement in Patients With Atrial Fibrillation
Author: 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
Abstract: 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
Subject: atrial fibrillation
cardiac magnetic resonance late
gadolinium enhancement
Country: EUA
Editor: Elsevier Science Inc
Rights: fechado
Identifier DOI: 10.1016/j.jacc.2013.07.067
Date Issue: 2013
Appears in Collections:Unicamp - Artigos e Outros Documentos

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