PMID- 28882227 OWN - NLM STAT- MEDLINE DCOM- 20170919 LR - 20220408 IS - 1558-3597 (Electronic) IS - 0735-1097 (Linking) VI - 70 IP - 11 DP - 2017 Sep 12 TI - Left Atrial Fibrosis and Risk of Cerebrovascular and Cardiovascular Events in Patients With Atrial Fibrillation. PG - 1311-1321 LID - S0735-1097(17)38974-X [pii] LID - 10.1016/j.jacc.2017.07.758 [doi] AB - BACKGROUND: Severity of left atrial (LA) fibrosis is a strong predictor of atrial fibrillation (AF) ablation success and has been associated with a history of stroke, hypertension, and heart failure (HF). However, it is unclear whether more severe LA fibrosis independently increases the risk of major adverse cardiovascular and cerebrovascular events (MACCE) among those with AF. OBJECTIVES: The goal of this study was to evaluate the occurrence and frequency of MACCE by strata of LA fibrosis severity in patients with AF. METHODS: This was a retrospective cohort study of 1,228 patients with AF who underwent late gadolinium enhancement (LGE)-cardiac magnetic resonance imaging to quantify LA fibrosis severity between January 2007 and June 2015. Patients were stratified according to Utah stage of LA LGE criteria, and observed for the occurrence of MACCE, which included a composite of stroke or transient ischemic attack (TIA), myocardial infarction, acute decompensated HF, or cardiovascular death. Disease risk score (DRS) stratification was used to control for between-group differences in baseline characteristics and risk. RESULTS: During follow-up, 62 strokes or TIAs, 42 myocardial infarctions, 156 HF events, and 38 cardiovascular deaths occurred. In DRS stratified analysis, the hazard ratio comparing patients with stage IV versus stage I LA LGE was 1.67 (95% confidence interval: 1.01 to 2.76) for the composite MACCE outcome. The only individual component of the MACCE outcome to remain significantly associated with advanced LGE following DRS stratification was stroke or TIA (hazard ratio: 3.94; 95% confidence interval: 1.72 to 8.98). CONCLUSIONS: This retrospective analysis demonstrated that more severe LA LGE is associated with increased MACCE risk, driven primarily by increased risk of stroke or TIA. CI - Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - King, Jordan B AU - King JB AD - Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado; CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah. FAU - Azadani, Peyman N AU - Azadani PN AD - CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah; Cedars-Sinai Medical Center, Los Angeles, California. FAU - Suksaranjit, Promporn AU - Suksaranjit P AD - CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah. FAU - Bress, Adam P AU - Bress AP AD - Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah. FAU - Witt, Daniel M AU - Witt DM AD - Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah. FAU - Han, Frederick T AU - Han FT AD - CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah. FAU - Chelu, Mihail G AU - Chelu MG AD - CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah. FAU - Silver, Michelle A AU - Silver MA AD - CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah. FAU - Biskupiak, Joseph AU - Biskupiak J AD - Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah. FAU - Wilson, Brent D AU - Wilson BD AD - CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah. FAU - Morris, Alan K AU - Morris AK AD - CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah. FAU - Kholmovski, Eugene G AU - Kholmovski EG AD - CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah; UCAIR, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah. FAU - Marrouche, Nassir AU - Marrouche N AD - CARMA Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, Utah. Electronic address: nassir.marrouche@hsc.utah.edu. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - IM CIN - J Am Coll Cardiol. 2017 Sep 12;70(11):1322-1324. PMID: 28882228 CIN - J Am Coll Cardiol. 2018 Mar 6;71(9):1053-1054. PMID: 29495988 CIN - J Am Coll Cardiol. 2018 Mar 6;71(9):1054-1056. PMID: 29495989 MH - Aged MH - Atrial Fibrillation/*complications/diagnosis MH - Cause of Death/trends MH - Female MH - Fibrosis/complications/diagnosis MH - Follow-Up Studies MH - Heart Atria/*pathology MH - Humans MH - Incidence MH - Ischemic Attack, Transient/diagnosis/epidemiology/*etiology MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Myocardial Infarction/diagnosis/epidemiology/*etiology MH - Prognosis MH - Retrospective Studies MH - Risk Factors MH - Survival Rate/trends MH - Utah/epidemiology OTO - NOTNLM OT - MACCE OT - arrhythmia OT - cardiomyopathy OT - stroke EDAT- 2017/09/09 06:00 MHDA- 2017/09/20 06:00 CRDT- 2017/09/09 06:00 PHST- 2017/04/26 00:00 [received] PHST- 2017/07/06 00:00 [revised] PHST- 2017/07/17 00:00 [accepted] PHST- 2017/09/09 06:00 [entrez] PHST- 2017/09/09 06:00 [pubmed] PHST- 2017/09/20 06:00 [medline] AID - S0735-1097(17)38974-X [pii] AID - 10.1016/j.jacc.2017.07.758 [doi] PST - ppublish SO - J Am Coll Cardiol. 2017 Sep 12;70(11):1311-1321. doi: 10.1016/j.jacc.2017.07.758.