Abstract 17865: The Presence of Left Ventricular Scar in Atrial Fibrillation is associated with Major Adverse Cardiovascular Events
Introduction: Left ventricular (LV) scar identified by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging is associated with adverse cardiovascular outcomes in patients with coronary artery disease (CAD) and cardiomyopathies. We studied the prognostic significance of LV-LGE in patients with atrial fibrillation (AF).
Methods: We studied 778 consecutive patients referred for radiofrequency ablation of AF who underwent CMR exams between June 2006 and January 2013. Patients with history of CAD, prior myocardial infarction (MI), hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) were excluded (24 patients). The presence of LV-LGE was assessed by two independent observers who were blinded to the clinical data and outcomes. The endpoint of interest was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, MI and ischemic stroke. MACE was determined by systematic retrospective review of electronic medical records and ICD-9 codes. Univariate and multivariate analysis were performed to identify predictors of MACE.
Results: Of the 754 patients who met the inclusion criteria, 60% were male with an average age of 64 years and 87% had LV ejection fraction ≥ 55%. LV-LGE was found in 46 (6%) patients. There were 32 MACE over the mean follow up period of 53 months. The MACE rate was 13% in AF patient with LV-LGE compared to 3.7% in patient without LV-LGE (p = 0.002). In univariable analysis, age (HR 1.05, CI 1.01-10.9, p = 0.005), prior stroke (HR 1.64, CI 1.08-2.49, p = 0.021), CHADS2 (HR 1.75, CI 1.34-2.27, p < 0.001), CHA2DS2-VASc (HR 1.32, CI 1.15-1.52, p < 0.001), left atrial fibrosis (HR 1.66, CI 1.41-1.96, p < 0.001) and LV-LGE (HR 3.68, CI 1.52-8.95, p = 0.004) were significantly associated with MACE. In multivariate analysis, age and LV-LGE were independent predictors of MACE.
Conclusions: In this large cohort of AF patients, LV -LGE is shown to be an independent predictor of MACE.
Author Disclosures: P. Suksaranjit: None. N. Akoum: None. B.D. Wilson: None. J. Biskupiak: None. L. Chang: None. K. Velagapudi: None. L. Navaravong: None. K. Damal: None. A. Rassa: None. E. Bieging: None. N. Marrouche: Research Grant; Modest; estech, Sanofi, Biotronik, eCardio. Honoraria; Modest; estech. Ownership Interest; Significant; Marrek, MRI-Inerventions. C.J. McGann: None.
- © 2014 by American Heart Association, Inc.