Author + information
- Received May 6, 2013
- Revision received June 21, 2013
- Accepted July 8, 2013
- Published online December 10, 2013.
- Tomas G. Neilan, MD∗,†,‡,
- Ravi V. Shah, MD∗,†,
- Siddique A. Abbasi, MD∗,
- Hoshang Farhad, MD∗,
- John D. Groarke, MD∗,
- John A. Dodson, MD§,
- Otavio Coelho-Filho, MD, MPH∗,‖,
- Ciaran J. McMullan, MD¶,
- Bobak Heydari, MD∗,
- Gregory F. Michaud, MD∗,
- Roy M. John, MD, PhD∗,
- Rob van der Geest, PhD#,
- Michael L. Steigner, MD∗∗,
- Ron Blankstein, MD∗,
- Michael Jerosch-Herold, PhD∗∗ and
- Raymond Y. Kwong, MD, MPH∗∗ ()
- ∗Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
- †Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- ‡Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
- §Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts
- ‖Department of Internal Medicine, State University of Campinas, Campinas, Brazil
- ¶Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- #Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
- ∗∗Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Raymond Y. Kwong, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115.
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 [LRχ2]: 15.2; p = 0.0001), diabetes (HR: 2.39; 95% CI: 1.41 to 4.09; LRχ2: 10.3; p = 0.001), a history of heart failure (HR: 1.78; 95% CI: 1.09 to 2.91; LRχ2: 5.37; p = 0.02), left atrial dimension (HR: 1.04; 95% CI: 1.01 to 1.08; LRχ2: 6.47; p = 0.01), presence of LGE (HR: 5.08; 95% CI: 3.08 to 8.36; LRχ2: 28.8; p < 0.0001), and LGE extent (HR: 1.15; 95% CI: 1.10 to 1.21; LRχ2: 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.
Dr. Neilan is supported by an American Heart Association Fellow to Faculty Grant (12FTF12060588). Dr. Abbassi has received NIH funding. Drs. Jerosch-Herold and Kwong are supported by research grants from the National Institutes of Health (RO1HL090634 and RO1HL091157, respectively). Dr. Shah has served as a consultant for Ventripoint. Dr. John has received a speaking honorarium from St. Jude Medical. Dr. van der Geest is a consultant for Medis Medical Imaging Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 6, 2013.
- Revision received June 21, 2013.
- Accepted July 8, 2013.
- American College of Cardiology Foundation