Association of atrial fibrosis quantified using LGE-MRI with atrial appendage thrombus and spontaneous contrast on transesophageal echocardiography in patients with atrial fibrillation.
Association of atrial fibrosis quantified using LGE-MRI with atrial appendage thrombus and spontaneous contrast on transesophageal echocardiography in patients with atrial fibrillation.
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DOI：
10.1111/jce.12199
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发表时间：
2013-10
影响因子：
2.7
通讯作者：
Marrouche N
中科院分区：
文献类型：
--
作者：
Akoum N;Fernandez G;Wilson B;Mcgann C;Kholmovski E;Marrouche N
经食道超声心动图(TEE)用于评估房颤(AF)恢复窦性心律前左心耳(LAA)血栓。我们研究了使用晚期Gd增强MRI(LGE-MRI)量化的心房纤维化与TEE结果的关系。我们纳入了178例房颤患者，在消融或复律前接受TEE和LGE-MRI检查。在信号强度分析的基础上，采用LGE-MRI及后续图像处理技术对心房纤维化进行量化。CHADS2评分为1.24±1.08，CHA2DS2-VASc为2.08±1.33。LAA分为正常、自发性回声对比(SEC)或血栓。12例(6.7%)发现左心耳血栓，19例(10.7%)发现SEC。有血栓的患者较无血栓的患者有更高的心房纤维化(26.9±17.4%比16.7±10.5%；p<；0.01)。有SEC患者的心房纤维化发生率(23.3±13.7%)高于无SEC患者(16.7±10.8%；P=0.01)。心房纤维化程度高(>；20%)的患者更有可能出现左心耳血栓(优势比4.6；p=0.02)和SEC(优势比2.6；p=0.06)。多因素Logistic回归分析显示高纤维化(优势比3.6；P<0.0 1)和CHADS 2≥2(优势比3.5；P<0.0 1)是TEE异常(左心耳血栓或SEC)的显著预测因素。包括高纤维化、房颤型和CHADS2≥2或CHA2 DS2-VASc≥2模型的曲线下面积分别为0.73和0.6 3，而单纯CHA2DS2-VASc模型为0.6 5。心房纤维化与心耳血栓和自发性对比度独立相关。它提供了临床参数没有捕捉到的额外风险分层。
Transesophageal echocardiography (TEE) is used to evaluate for left atrial appendage (LAA) thrombi prior to restoration of sinus rhythm in atrial fibrillation (AF). We examined the relationship of atrial fibrosis quantified using late gadolinium enhancement MRI (LGE-MRI) with TEE findings. We included 178 patients with AF, undergoing TEE and LGE-MRI prior to ablation or cardioversion. LGE-MRI and subsequent image processing was used to quantify atrial fibrosis based on signal intensity analysis. The mean CHADS2 score was 1.24±1.08 and CHA2DS2-VASc was 2.08±1.33. The LAA was classified as normal, spontaneous echo contrast (SEC) present or thrombus present. LAA thrombus was found in 12 patients (6.7%) while SEC was identified in 19 patients (10.7%). Patients with thrombus had higher atrial fibrosis compared to patients without thrombus (26.9±17.4% vs 16.7±10.5%; p<0.01). Atrial fibrosis was also higher in patients with SEC (23.3±13.7%) compared to those without SEC (16.7±10.8%; p=0.01). Patients with high atrial fibrosis (>20%) were more likely to have a LAA thrombus (Odds Ratio 4.6; p=0.02) and SEC (Odds ratio 2.6; p=0.06). Multivariate logistic regression showed high fibrosis (Odds Ratio 3.6; p<0.01) and CHADS2≥2 (Odds Ratio 3.5; p<0.01) were significant predictors of TEE abnormalities (LAA thrombus or SEC). The area under the curve for the model including high fibrosis, AF type and CHADS2≥2 or CHA2DS2-VASc≥2 was 0.73 compared to 0.63 and 0.65 for CHADS2 and CHA2DS2-VASc alone. Atrial fibrosis is independently associated with appendage thrombus and spontaneous contrast. It provides additional risk stratification not captured by clinical parameters.
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影响因子：
37.8
作者：
Roger VL;Go AS;Lloyd-Jones DM;Benjamin EJ;Berry JD;Borden WB;Bravata DM;Dai S;Ford ES;Fox CS;Fullerton HJ;Gillespie C;Hailpern SM;Heit JA;Howard VJ;Kissela BM;Kittner SJ;Lackland DT;Lichtman JH;Lisabeth LD;Makuc DM;Marcus GM;Marelli A;Matchar DB;Moy CS;Mozaffarian D;Mussolino ME;Nichol G;Paynter NP;Soliman EZ;Sorlie PD;Sotoodehnia N;Turan TN;Virani SS;Wong ND;Woo D;Turner MB;American Heart Association Statistics Committee and Stroke Statistics Subcommittee
通讯作者：
American Heart Association Statistics Committee and Stroke Statistics Subcommittee
影响因子：
37.8
作者：
Wang, TJ;Larson, MG;Benjamin, EJ
通讯作者：
Benjamin, EJ
影响因子：
37.8
作者：
Oakes RS;Badger TJ;Kholmovski EG;Akoum N;Burgon NS;Fish EN;Blauer JJ;Rao SN;DiBella EV;Segerson NM;Daccarett M;Windfelder J;McGann CJ;Parker D;MacLeod RS;Marrouche NF
通讯作者：
Marrouche NF
DOI：
10.1016/s0735-1097(86)80275-3
发表时间：
1986-01-01
影响因子：
24
作者：
ASCHENBERG, W;SCHLUTER, M;BLEIFELD, W
通讯作者：
BLEIFELD, W
影响因子：
5.7
作者：
Dulli, DA;Stanko, H;Levine, RL
通讯作者：
Levine, RL