Author + information
- Received April 26, 2017
- Revision received July 6, 2017
- Accepted July 17, 2017
- Published online September 4, 2017.
- Jordan B. King, PharmD, MSa,b,
- Peyman N. Azadani, MDb,c,
- Promporn Suksaranjit, MD, MSb,
- Adam P. Bress, PharmD, MSd,
- Daniel M. Witt, PharmDe,
- Frederick T. Han, MDb,
- Mihail G. Chelu, MD, PhDb,
- Michelle A. Silver, MSPHb,
- Joseph Biskupiak, PhD, MBAe,
- Brent D. Wilson, MD, PhDb,
- Alan K. Morris, MSb,
- Eugene G. Kholmovski, PhDb,f and
- Nassir Marrouche, MDb,∗ ()
- aPharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado
- bCARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- cCedars-Sinai Medical Center, Los Angeles, California
- dDepartment of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
- eDepartment of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah
- fUCAIR, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
- ↵∗Address for correspondence:
Dr. Nassir F. Marrouche, CARMA Center, Division of Cardiology, University of Utah Health Sciences Center, 30 North 1900 East, Suite 4A100 SOM, Salt Lake City, Utah 84132.
Background Severity of left atrial (LA) fibrosis is a strong predictor of atrial fibrillation (AF) ablation success and has been associated with a history of stroke, hypertension, and heart failure (HF). However, it is unclear whether more severe LA fibrosis independently increases the risk of major adverse cardiovascular and cerebrovascular events (MACCE) among those with AF.
Objectives The goal of this study was to evaluate the occurrence and frequency of MACCE by strata of LA fibrosis severity in patients with AF.
Methods This was a retrospective cohort study of 1,228 patients with AF who underwent late gadolinium enhancement (LGE)–cardiac magnetic resonance imaging to quantify LA fibrosis severity between January 2007 and June 2015. Patients were stratified according to Utah stage of LA LGE criteria, and observed for the occurrence of MACCE, which included a composite of stroke or transient ischemic attack (TIA), myocardial infarction, acute decompensated HF, or cardiovascular death. Disease risk score (DRS) stratification was used to control for between-group differences in baseline characteristics and risk.
Results During follow-up, 62 strokes or TIAs, 42 myocardial infarctions, 156 HF events, and 38 cardiovascular deaths occurred. In DRS stratified analysis, the hazard ratio comparing patients with stage IV versus stage I LA LGE was 1.67 (95% confidence interval: 1.01 to 2.76) for the composite MACCE outcome. The only individual component of the MACCE outcome to remain significantly associated with advanced LGE following DRS stratification was stroke or TIA (hazard ratio: 3.94; 95% confidence interval: 1.72 to 8.98).
Conclusions This retrospective analysis demonstrated that more severe LA LGE is associated with increased MACCE risk, driven primarily by increased risk of stroke or TIA.
Dr. Bress was supported by 1K01HL133468-01 from the National Heart, Lung, and Blood Institute; and has received research support from Novartis not related to the current project. Dr. Han has received research funding from St. Jude Medical and Boston Scientific. Dr. Chelu has received research funding from Wavelet Health, Biotronik, Medtronic, and Boston Scientific. Mr. Morris has an ownership interest in Marrek Inc. Dr. Kholmovski has been a consultant for and has ownership interest in Marrek, Inc. Dr. Marrouche has an ownership interest in Marrek, Inc. and Cardiac Designs; has performed contracted research for Biosense Webster, Medtronic, St. Jude, Biotronik, and Boston Scientific; and has received consulting fees from Biotronik and Preventice. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2017.
- Revision received July 6, 2017.
- Accepted July 17, 2017.
- 2017 American College of Cardiology Foundation
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