Association of Atrial Fibrosis Quantified Using LGE-MRI with Atrial Appendage Thrombus and Spontaneous Contrast on Transesophageal Echocardiography in Patients with Atrial Fibrillation.
Atrial Fibrosis and Appendage Thrombus Introduction Transesophageal echocardiography (TEE) is used to evaluate for left atrial appendage (LAA) thrombi prior to restoration of sinus rhythm in atrial fibrillation (AF). We examined the relationship of atrial fibrosis quantified using late gadolinium en...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 24; no. 10; pp. 1104 - 1110 |
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| Autores principales: | , , , , , |
| Formato: | diagnostic images research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Oct2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104100910&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104100910 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Oct2013 vid: 24 iid: 10 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 104100910 90608019 10.1111/jce.12199 NLM23844972 104100910 ppf: 1104 ppct: 6 formats: fmt: @attributes: type: P tig: atl: Association of Atrial Fibrosis Quantified Using LGE-MRI with Atrial Appendage Thrombus and Spontaneous Contrast on Transesophageal Echocardiography in Patients with Atrial Fibrillation. aug: au: Akoum, Nazem Fernandez, Genaro Wilson, Brent Mcgann, Christopher Kholmovski, Eugene Marrouche, Nassir affil: Comprehensive Arrhythmia Research and Management (CARMA) Center, University of Utah sug: subj: Atrial Fibrillation Physiopathology Echocardiography, Transesophageal Catheter Ablation Coronary Thrombosis Diagnosis Risk Assessment Methods Fibrosis Diagnosis Heart Atrium Anatomy and Histology Stroke Magnetic Resonance Imaging Contrast Media Image Processing, Computer Assisted Clinical Assessment Tools Evaluation Research Interrater Reliability Random Sample Data Analysis Software T-Tests Fisher's Exact Test Logistic Regression Odds Ratio ROC Curve P-Value Multiple Logistic Regression Middle Age Aged Female Male Human Funding Source Middle Aged: 45-64 years Aged: 65+ years Female Male ab: Atrial Fibrosis and Appendage Thrombus Introduction Transesophageal echocardiography (TEE) is used to evaluate for left atrial appendage (LAA) thrombi prior to restoration of sinus rhythm in atrial fibrillation (AF). We examined the relationship of atrial fibrosis quantified using late gadolinium enhancement MRI (LGE-MRI) with TEE findings. Methods and Results We included 178 patients with AF, undergoing TEE and LGE-MRI prior to ablation or cardioversion. LGE-MRI and subsequent image processing was used to quantify atrial fibrosis based on signal intensity analysis. The mean CHADS2 score was 1.24 ± 1.08 and CHA2DS2-VASc was 2.08 ± 1.33. The LAA was classified as normal, spontaneous echocardiographic contrast (SEC) present or thrombus present. LAA thrombus was found in 12 patients (6.7%) while SEC was identified in 19 patients (10.7%). Patients with thrombus had higher atrial fibrosis compared to patients without thrombus (26.9 ± 17.4% vs 16.7 ± 10.5%; P < 0.01). Atrial fibrosis was also higher in patients with SEC (23.3 ± 13.7%) compared to those without SEC (16.7 ± 10.8%; P = 0.01). Patients with high atrial fibrosis (>20%) were more likely to have a LAA thrombus (odds ratio 4.6; P = 0.02) and SEC (odds ratio 2.6; P = 0.06). Multivariate logistic regression showed high fibrosis (odds ratio 3.6; P < 0.01) and CHADS2 ≥2 (odds ratio 3.5; P < 0.01) were significant predictors of TEE abnormalities (LAA thrombus or SEC). The area under the curve for the model including high fibrosis, AF type and CHADS2 ≥2 or CHA2DS2-VASc ≥2 was 0.73 compared to 0.63 and 0.65 for CHADS2 and CHA2DS2-VASc alone. Conclusions Atrial fibrosis is independently associated with appendage thrombus and spontaneous contrast. It provides additional risk stratification not captured by clinical parameters. pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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