Author + information
- Received June 2, 2010
- Revision received August 20, 2010
- Accepted September 13, 2010
- Published online February 15, 2011.
- Marcos Daccarett, MD, MSc⁎,
- Troy J. Badger, MD⁎,
- Nazem Akoum, MD⁎,
- Nathan S. Burgon, BSc⁎,
- Christian Mahnkopf, MD⁎,†,
- Gaston Vergara, MD⁎,
- Eugene Kholmovski, PhD⁎,
- Christopher J. McGann, MD⁎,
- Dennis Parker, PhD⁎,
- Johannes Brachmann, MD, PhD†,
- Rob S. MacLeod, PhD⁎ and
- Nassir F. Marrouche, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Nassir F. Marrouche, CARMA Center, Cardiac Electrophysiology Laboratories, Division of Cardiology, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, Utah 84132-2400
Objectives This study tried to determine the association between left atrial (LA) fibrosis, detected using delayed-enhanced magnetic resonance imaging (DE-MRI), and the CHADS2 score (point system based on individual clinical risk factors including congestive heart failure, hypertension, age, diabetes, and prior stroke) variables, specifically stroke.
Background In patients with atrial fibrillation (AF), conventional markers for the risk of stroke base their higher predictive effect on clinical features, particularly previous stroke history, and not individual LA pathophysiological properties. We aimed to determine the association between LA fibrosis, detected using DE-MRI, and the CHADS2 score variables, specifically stroke.
Methods Patients with AF who presented to the AF clinic and received a DE-MRI of the LA were evaluated. Their risk factor profiles, including a CHADS2 score, were catalogued. The degree of LA fibrosis was determined as a percentage of the LA area. Any history of previous strokes, warfarin use, or cerebrovascular disease was recorded.
Results A total of 387 patients, having a mean age of 65 ± 12 years, 36.8% female, were included in this study. A history of previous stroke was present in 36 (9.3%) patients. Those patients with previous strokes had a significantly higher percentage of LA fibrosis (24.4 ± 12.4% vs. 16.2 ± 9.9%, p < 0.01). A larger amount of LA fibrosis was also seen in those patients with a higher CHADS2 score (≥2: 18.7 ± 11.4 vs. <2: 14.7 ± 9.2, p < 0.01). A logistic regression analysis of all variables except strokes (CHAD score) demonstrated that LA fibrosis independently predicted cerebrovascular events (p = 0.002) and significantly increased the predictive performance of the score (area under the curve = 0.77).
Conclusions Our preliminary, multicenter results suggest DE-MRI–based detection of LA fibrosis is independently associated with prior history of strokes. We propose that the amount of DE-MRI–determined LA fibrosis could represent a marker for stroke and a possible therapeutic target with potential applicability for clinical treatment for patients with AF.
This work was made possible in part by software from the NIH/NCRR Center for Integrative Biomedical Computing, P41-RR12553-10.
Dr. Kholmovski is partially supported by a grant from Surgivision, Inc. All other authors have reported that they have no relationships to disclose.
- Received June 2, 2010.
- Revision received August 20, 2010.
- Accepted September 13, 2010.
- American College of Cardiology Foundation