The incidence, pattern, and prognostic value of left ventricular myocardial scar by late gadolinium enhancement in patients with atrial fibrillation .
The incidence, pattern, and prognostic value of left ventricular myocardial scar by late gadolinium enhancement in patients with atrial fibrillation .
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DOI：
10.1016/j.jacc.2013.07.067
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发表时间：
2013-12-10
影响因子：
24
通讯作者：
Kwong, Raymond Y.
中科院分区：
文献类型：
--
作者：
Neilan, Tomas G.;Shah, Ravi V.;Abbasi, Siddique A.;Farhad, Hoshang;Groarke, John D.;Dodson, John A.;Coelho-Filho, Otavio;McMullan, Ciaran J.;Heydari, Bobak;Michaud, Gregory F.;John, Roy M.;van der Geest, Rob;Steigner, Michael L.;Blankstein, Ron;Jerosch-Herold, Michael;Kwong, Raymond Y.
我们的目的是确定心房颤动 (AF) 患者左心室 (LV) 晚期钆增强 (LGE) 的频率、模式和预后意义。关于 AF 患者左心室心肌纤维化的存在、模式和预后意义的数据有限。心脏磁共振 (CMR) 期间的晚期钆增强是心肌纤维化的标志。我们连续研究了 664 名既往未患过心肌梗塞且被转诊接受 AF 射频消融术的患者。要求 CMR 评估肺静脉解剖结构。总体而言，73% 为男性，平均年龄 56 岁，射血分数为 55±10%。 88 名患者 (13%) 发现左心室 LGE。终点是全因死亡率，在该队列中，我们在 42 个月的中位随访期内观察到 68 例死亡。单变量分析显示，年龄（HR 1.05，CI 1.03–1.08，LRχ2 15.2，p=0.0001），糖尿病（HR 2.39，CI 1.41–4.09，LRχ210.3，p=0.001），心力衰竭病史（HR 1.78，CI 1.09–2.91，LRχ2） 5.37，p=0.02)，左心房 尺寸（HR 1.04，CI 1.01–1.08，LRχ2 6.47，p=0.01），存在 LGE（HR 5.08，CI 3.08–8.36，LRχ2 28.8，p<0.0001），以及 LGE 范围（HR 1.15，CI 1.10–1.21，LRχ2 35.6， p<0.0001）与死亡率的相关性最强。 LGE 患者的死亡率为每患者年 8.1%，而无 LGE 患者的死亡率为 2.3%。在最佳的总体死亡率多变量模型中，年龄和 LGE 的程度是死亡率的独立预测因素。事实上，LGE 每增加 1%，死亡风险就会增加 15%。在 AF 患者中，左室 LGE 很常见，并且是死亡率的有力预测因子。
We aimed to identify the frequency, pattern, and prognostic significance of left ventricular (LV) late gadolinium enhancement (LGE) in patients with atrial fibrillation (AF). There are limited data on the presence, pattern, and prognostic significance of LV myocardial fibrosis in patients with AF. Late gadolinium enhancement during cardiac magnetic resonance (CMR) is a marker for myocardial fibrosis. We studied a consecutive group of 664 patients without known prior myocardial infarction being referred for radiofrequency ablation of AF. CMR was requested to assess pulmonary venous anatomy. Overall, 73% were male, with an average age of 56 years, and an ejection fraction of 55±10%. Left ventricular LGE was found in 88 patients (13%). The endpoint was all-cause mortality, and in this cohort we observed 68 deaths over a median follow-up period of 42 months. On univariable analysis, age (HR 1.05, CI 1.03–1.08, LRχ2 15.2, p=0.0001), diabetes (HR 2.39, CI 1.41–4.09, LRχ210.3, p=0.001), a history of heart failure (HR 1.78, CI 1.09–2.91, LRχ2 5.37, p=0.02), left atrial dimension (HR 1.04, CI 1.01–1.08, LRχ2 6.47, p=0.01), presence of LGE (HR 5.08, CI 3.08–8.36, LRχ2 28.8, p<0.0001), and LGE extent (HR 1.15, CI 1.10–1.21, LRχ2 35.6, p<0.0001) provided the strongest association with mortality. The mortality rate was 8.1% per patient-years in patients with LGE vs. 2.3% patients without LGE. In the best overall multivariable model for mortality, age and the extent of LGE were independent predictors of mortality. Indeed, each 1% increase in LGE associated with a 15% increased risk of death. In patients with AF, LV LGE is a frequent finding and is a powerful predictor of mortality.
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