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Myocardial Extracellular Volume Expansion and the Risk of Recurrent Atrial Fibrillation After Pulmonary Vein Isolation.
MedLine Citation:
PMID:  24290570     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: We tested whether myocardial extracellular volume (ECV) is increased in patients with hypertension and atrial fibrillation (AF) undergoing pulmonary vein isolation and whether there is an association between ECV and post-procedural recurrence of AF.
BACKGROUND: Hypertension is associated with myocardial fibrosis, an increase in ECV, and AF. Data linking these findings are limited. T1 measurements pre-contrast and post-contrast in a cardiac magnetic resonance (CMR) study provide a method for quantification of ECV.
METHODS: Consecutive patients with hypertension and recurrent AF referred for pulmonary vein isolation underwent a contrast CMR study with measurement of ECV and were followed up prospectively for a median of 18 months. The endpoint of interest was late recurrence of AF.
RESULTS: Patients had elevated left ventricular (LV) volumes, LV mass, left atrial volumes, and increased ECV (patients with AF, 0.34 ± 0.03; healthy control patients, 0.29 ± 0.03; p < 0.001). There were positive associations between ECV and left atrial volume (r = 0.46, p < 0.01) and LV mass and a negative association between ECV and diastolic function (early mitral annular relaxation [E'], r = -0.55, p < 0.001). In the best overall multivariable model, ECV was the strongest predictor of the primary outcome of recurrent AF (hazard ratio: 1.29; 95% confidence interval: 1.15 to 1.44; p < 0.0001) and the secondary composite outcome of recurrent AF, heart failure admission, and death (hazard ratio: 1.35; 95% confidence interval: 1.21 to 1.51; p < 0.0001). Each 10% increase in ECV was associated with a 29% increased risk of recurrent AF.
CONCLUSIONS: In patients with AF and hypertension, expansion of ECV is associated with diastolic function and left atrial remodeling and is a strong independent predictor of recurrent AF post-pulmonary vein isolation.
Authors:
Tomas G Neilan; Francois-Pierre Mongeon; Ravi V Shah; Otavio Coelho-Filho; Siddique A Abbasi; John A Dodson; Ciaran J McMullan; Bobak Heydari; Gregory F Michaud; Roy M John; Ron Blankstein; Michael Jerosch-Herold; Raymond Y Kwong
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-20
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  -     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-12-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Cardiac MR PET CT Program, Division of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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