Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, 28644, Republic of Korea.
Sci Rep. 2020 Oct 5;10(1):16486. doi: 10.1038/s41598-020-72929-0.
Atrial remodeling with fibrosis has been well-described in patients with atrial fibrillation (AF). We hypothesized that the left atrial (LA)-late gadolinium enhancement (LGE) extent on cardiac magnetic resonance (CMR) imaging is associated with LA pressure and can be a marker for suitable candidates for non-paroxysmal AF ablation. A total of 173 AF patients with an LA-LGE area on CMR imaging were enrolled. The clinical parameters, including invasively measured LA pressure, were compared between the patients with extensive LA-LGE (E-LGE, LGE extent ≥ 20%, n = 78) and those with small LA-LGE (S-LGE, LGE extent < 20%, n = 95). The E-LGE group had higher peak LA pressures than the S-LGE group (23 versus 19 mmHg, p < 0.001). The E-LGE group had more patients with non-paroxysmal AF (non-PAF) (51% vs. 34%), heart failure (9% vs. 0%), and higher NT pro-B-type natriuretic peptide (472 vs. 265 pg/ml) (all p < 0.05). LA pressure ≥ 21 mmHg was an independent predictor of E-LGE (OR = 2.218; p = 0.019). In the paroxysmal AF (PAF) subgroup, freedom from atrial arrhythmia after catheter ablation was not different (81% vs 86%, log-rank p = 0.529). However, in the non-PAF subgroup, it was significantly higher in the S-LGE group than in the E-LGE group (81% vs 55%, log-rank p = 0.014). Increased LA pressure was related to the LA-LGE extent. LA-LGE was a good predictor of outcome after catheter ablation, but only in patients with non-PAF.
心房纤维化重构在心房颤动（AF）患者中已有很好的描述。我们假设心脏磁共振（CMR）成像上左心房（LA）晚期钆增强（LGE）程度与 LA 压力相关，并且可以作为非阵发性 AF 消融的合适候选者的标志物。共纳入 173 例 CMR 成像上有 LA-LGE 区域的 AF 患者。比较了广泛 LA-LGE（E-LGE，LGE 程度≥20%，n=78）和小 LA-LGE（S-LGE，LGE 程度<20%，n=95）患者的临床参数，包括侵入性测量的 LA 压力。E-LGE 组的峰值 LA 压力高于 S-LGE 组（23 对 19mmHg，p<0.001）。E-LGE 组中非阵发性 AF（非 PAF）患者更多（51%对 34%）、心力衰竭（9%对 0%）和更高的 NT 前 B 型利钠肽（472 对 265pg/ml）（均 p<0.05）。LA 压力≥21mmHg 是 E-LGE 的独立预测因子（OR=2.218；p=0.019）。在阵发性 AF（PAF）亚组中，导管消融后心房心律失常无复发的比例在两组间无差异（81%对 86%，log-rank p=0.529）。然而，在非 PAF 亚组中，S-LGE 组明显高于 E-LGE 组（81%对 55%，log-rank p=0.014）。LA 压力增加与 LA-LGE 程度相关。LA-LGE 是导管消融后结果的良好预测因子，但仅在非 PAF 患者中如此。
