Li Songnan, Zhao Lei, Ma Xiaohai, Bai Rong, Tian Jie, Selvanayagam Joseph B
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Cardiovasc Diagn Ther. 2019 Dec;9(6):578-585. doi: 10.21037/cdt.2019.12.03.
Left ventricular (LV) extracellular volume fraction (ECV) provides prognostic information in patients with variety of cardiomyopathies. However, data on the clinical significance of LV ECV in patients with atrial fibrillation (AF), especially in patients without replacement fibrosis are sparse. This study sought to investigate whether the presence of LV fibrosis identified by cardiac magnetic resonance (CMR) ECV quantification would independently predict the recurrence of AF after first catheter ablation (CA) in patients with AF.
A total of 130 consecutive patients who were referred for CA of AF underwent CMR examination prior to ablation. LV function, T1 mapping derived LV ECV, LV late gadolinium enhancement (LGE) were assessed. Patients were followed for arrhythmia recurrence after the CA procedure.
Of 130 AF patients, 65 patients had paroxysmal AF, and 65 patients had persistent AF. There were 50 AF recurrences over a median follow-up period of 13 months. LV ECV were significantly higher in patients with recurrent AF compared to those with no recurrence (30.4%±3.3% . 27.4%±2.9%, P<0.001). In multivariable model, gender (HR: 0.348, 95% CI: 0.174-0.697, P=0.003), body mass index (BMI) (HR: 1.159, 95% CI: 1.050-1.279, P=0.003), AF duration (HR: 1.006, 95% CI: 1.001-1.011, P=0.017), and LV ECV (HR: 1.158, 95% CI: 1.071-1.251, P=0.000) were significantly associated with AF recurrence. In subgroup of patients without LGE, gender, BMI, AF duration and LV ECV were still the independent predictors of AF recurrence.
LV ECV expansion is associated with AF recurrence after CA and is a strong independent predictor of AF recurrence.
左心室（LV）细胞外容积分数（ECV）可为多种心肌病患者提供预后信息。然而，关于心房颤动（AF）患者左心室ECV临床意义的数据，尤其是在无替代纤维化患者中的数据较为稀少。本研究旨在探讨通过心脏磁共振（CMR）ECV定量识别的左心室纤维化是否能独立预测AF患者首次导管消融（CA）后AF的复发。
共有130例因AF接受CA治疗的连续患者在消融前接受了CMR检查。评估左心室功能、T1映射得出的左心室ECV、左心室延迟钆增强（LGE）。对患者进行CA术后心律失常复发情况的随访。
130例AF患者中，65例为阵发性AF，65例为持续性AF。在中位随访期13个月内有50例AF复发。复发AF患者的左心室ECV显著高于未复发患者（30.4%±3.3% 对27.4%±2.9%，P<0.001）。在多变量模型中，性别（HR：0.348，95%CI：0.174 - 0.697，P = 0.003）、体重指数（BMI）（HR：1.159，95%CI：1.050 - 1.279，P = 0.003）、AF持续时间（HR：1.006，95%CI：1.001 - 1.011，P = 0.017）和左心室ECV（HR：1.158，95%CI：1.071 - 1.251，P = 0.000）与AF复发显著相关。在无LGE的患者亚组中，性别、BMI、AF持续时间和左心室ECV仍是AF复发的独立预测因素。
左心室ECV扩大与CA术后AF复发相关，是AF复发的强有力独立预测因素。
