PMID- 26376379
OWN - NLM
STAT- MEDLINE
DCOM- 20151215
LR  - 20221005
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 94
IP  - 37
DP  - 2015 Sep
TI  - Prevalence, Patterns, and Clinical Predictors of Left Ventricular Late Gadolinium 
      Enhancement in Patients Undergoing Cardiac Magnetic Resonance Prior to Pulmonary 
      Vein Antral Isolation for Atrial Fibrillation: A Cross-Sectional Observational 
      Study.
PG  - e1384
LID - 10.1097/MD.0000000000001384 [doi]
LID - e1384
AB  - Cardiac magnetic resonance (CMR) imaging is increasingly used to evaluate 
      patients with atrial fibrillation (AF) before pulmonary vein antral isolation 
      (PVAI). The purpose of this study was to assess the incidence and pattern of left 
      ventricular (LV) late gadolinium enhancement (LGE) in patients undergoing CMR 
      before PVAI and compare the clinical and demographic differences of patients with 
      and without LV LGE. Clinical and demographic data on 62 patients (mean age 
      61 +/- 7.9, 69% male) undergoing CMR before PVAI for AF were collected. Two 
      observers, masked to clinical histories, independently recorded the prevalence, 
      extent (number of myocardial segments), and pattern (subendocardial, 
      midmyocardial, or subepicardial) of LV LGE in each patient. Clinical and 
      demographic predictors of LV LGE were determined using logistic regression. 
      Twenty-three patients (37%) demonstrated LV LGE affecting a mean of 3.0 +/- 2.1 
      myocardial segments. There was no difference in LV ejection fraction between 
      patients with and without LGE, and most (65%) patients with LGE had normal wall 
      motion. Only age (P = 0.04) and a history of congestive heart failure (P = .03) 
      were statistically significant independent predictors of LGE. The most common LGE 
      pattern was midmyocardial, seen in 17 of 23 (74%) patients. Only 4 of 23 (17%) 
      patients had LGE in an "expected" pattern based on clinical history. Of the 
      remaining 19 patients, 4 had known congestive heart failure, 5 nonischemic 
      cardiomyopathy, 4 known coronary artery disease, and 2 prior aortic valve 
      replacement. Six of 23 (26%) patients had no known coronary artery, valvular, or 
      myocardial disease. There is a high prevalence of unexpected LV scar in patients 
      undergoing CMR before PVAI for AF, with most patients demonstrating a nonischemic 
      pattern of LV LGE and no wall motion abnormalities (ie, subclinical disease). The 
      high prevalence of unexpected LGE in these patients may argue for CMR as the 
      modality of choice for imaging integration before PVAI, especially given the 
      demonstrated prognostic value of LGE in this and other patient populations.
FAU - Nance, John W Jr
AU  - Nance JW Jr
AD  - From the Department of Radiology (JWNJ, SLZ); and Department of 
      Medicine/Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD (IMK, SN, 
      JD, HC).
FAU - Khurram, Irfan M
AU  - Khurram IM
FAU - Nazarian, Saman
AU  - Nazarian S
FAU - DeWire, Jane
AU  - DeWire J
FAU - Calkins, Hugh
AU  - Calkins H
FAU - Zimmerman, Stefan L
AU  - Zimmerman SL
LA  - eng
GR  - K23 HL089333/HL/NHLBI NIH HHS/United States
GR  - R01 HL116280/HL/NHLBI NIH HHS/United States
GR  - K23HL089333/HL/NHLBI NIH HHS/United States
GR  - R01HL116280/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Aged
MH  - Atrial Fibrillation/*pathology/surgery
MH  - Cross-Sectional Studies
MH  - Female
MH  - *Gadolinium
MH  - Heart Ventricles/*pathology
MH  - Humans
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
PMC - PMC4635793
COIS- The authors have no funding and conflicts of interest to disclose.
EDAT- 2015/09/17 06:00
MHDA- 2015/12/17 06:00
PMCR- 2015/09/18
CRDT- 2015/09/17 06:00
PHST- 2015/09/17 06:00 [entrez]
PHST- 2015/09/17 06:00 [pubmed]
PHST- 2015/12/17 06:00 [medline]
PHST- 2015/09/18 00:00 [pmc-release]
AID - 00005792-201509030-00011 [pii]
AID - 10.1097/MD.0000000000001384 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2015 Sep;94(37):e1384. doi: 10.1097/MD.0000000000001384.