Author + information
- Tomas G. Neilan, MD∗ ( and )
- Raymond Y. Kwong, MD, MPH
- ↵∗Division of Cardiology, Department of Medicine, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, VBK-508, Boston, Massachusetts 02114
We thank Drs. Kannan and Balamuthusamy for their interest in our report (1) and appreciate the opportunity to reply. Among our entire cohort of 720 patients, 44 of the 108 cases of abnormal late gadolinium enhancement (LGE) were non–infarct-appearing LGE (epicardial, midmyocardial, or patchy) and 64 cases were infarct appearing (Table 2 in our report). Thus, in our observation cohort, infarct-appearing LGE was the dominant factor that accounted for the prognostic association between LGE and mortality in patients with atrial fibrillation referred for cardiac magnetic resonance. In our subanalysis with patients with infarct LGE excluded, as shown in Table 5 in our report, non–infarct-appearing LGE also showed a strong association with mortality (hazard ratio: 4.21; p < 0.0001). Therefore, based on our experience, patients with atrial fibrillation referred for cardiac magnetic resonance may have LGE as a result of either infarction or noncoronary pathology, and both of these findings portend an elevated risk of mortality. Regarding the different patterns of noninfarct LGE (epicardial, midmyocardial, or patchy), our study was not designed or powered to assess their respective prognostic associations with patient mortality.
- American College of Cardiology Foundation