Abstract 14088: Advanced Chronic Kidney Disease Is Associated With Increased LGE-MRI Quantified Atrial Fibrosis in Patients with Atrial Fibrillation
Background: Chronic kidney disease (CKD) is independently associated with worse cardiovascular outcomes as well as a higher prevalence of atrial fibrillation (AF). We sought to examine the correlation of CKD with atrial fibrosis assessed using late gadolinium-enhancement MRI (LGE-MRI).
Methods: Four hundred and ninety six patients with AF, presenting for catheter ablation at the University of Utah were included in this study. All patients underwent LGE-MRI prior to catheter ablation of AF. Left atrial fibrosis (LA) was quantified using the Coreview software and was reported as a proportion of the LA wall volume. Creatinine clearance (CrCl) was calculated using the Cockroft-Gault equation. Patients were classified into CKD class I if their CrCl≥90, CKD class 2 if 60<CrCl≤89, CKD class 3 if 30<CrCl≤59, CKD class 4 if 15<CrCl≤29 and CKD class 5 if CrCl≤15.
Results: The average CrCl was 94.1±40.4% for the entire cohort. 235 patients (47.7%) fell into CKD class 1, followed by CKD class 2 (172 patients, 34.9%); CKD class 3 (83 patients, 16.8%) and CKD class 4 (3 patients, 0.6%). No patients in this cohort had CKD stage 5 as this constituted a contraindication to gadolinium contrast administration. The mean LA fibrosis of the cohort was 16.2±10.7%. The mean LA fibrosis was comparable in CKD stages 1 and 2 (15.6±10.5% vs 15.5±10.3%, p=0.95). Compared to CKD class 1 and 2, LA fibrosis was significantly higher in CKD stage 3 (18.6±11.6%; p=0.03), and CKD stage 4 (25.2±13.2%; p=0.03) (figure). Atrial fibrosis was the strongest predictor of AF recurrence post ablation (HR 1.05 per % increase, p<0.01).
Conclusions: Advanced stages of chronic kidney disease are associated with a significantly increased burden of left atrial fibrosis in patients with atrial fibrillation. This finding has potential management implications of the arrhythmia in this subgroup.
- © 2011 by American Heart Association, Inc.