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Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method

AIMS: With recurrence rates up to 50% after pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF), predictive tools to improve patient selection are needed. Patient selection based on left atrial late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been propo...

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Autores principales: Althoff, Till F, Eichenlaub, Martin, Padilla-Cueto, David, Lehrmann, Heiko, Garre, Paz, Schoechlin, Simon, Ferro, Elisenda, Invers, Eric, Ruile, Philipp, Hein, Manuel, Schlett, Christopher, Figueras i Ventura, Rosa M, Prat-Gonzalez, Susanna, Mueller-Edenborn, Bjoern, Bohnen, Marius, Porta-Sanchez, Andreu, Tolosana, Jose Maria, Guasch, Eduard, Roca-Luque, Ivo, Arbelo, Elena, Neumann, Franz-Josef, Westermann, Dirk, Sitges, Marta, Brugada, Josep, Arentz, Thomas, Mont, Lluís, Jadidi, Amir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9838794/
https://www.ncbi.nlm.nih.gov/pubmed/36654964
http://dx.doi.org/10.1093/ehjopen/oeac085
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author Althoff, Till F
Eichenlaub, Martin
Padilla-Cueto, David
Lehrmann, Heiko
Garre, Paz
Schoechlin, Simon
Ferro, Elisenda
Invers, Eric
Ruile, Philipp
Hein, Manuel
Schlett, Christopher
Figueras i Ventura, Rosa M
Prat-Gonzalez, Susanna
Mueller-Edenborn, Bjoern
Bohnen, Marius
Porta-Sanchez, Andreu
Tolosana, Jose Maria
Guasch, Eduard
Roca-Luque, Ivo
Arbelo, Elena
Neumann, Franz-Josef
Westermann, Dirk
Sitges, Marta
Brugada, Josep
Arentz, Thomas
Mont, Lluís
Jadidi, Amir
author_facet Althoff, Till F
Eichenlaub, Martin
Padilla-Cueto, David
Lehrmann, Heiko
Garre, Paz
Schoechlin, Simon
Ferro, Elisenda
Invers, Eric
Ruile, Philipp
Hein, Manuel
Schlett, Christopher
Figueras i Ventura, Rosa M
Prat-Gonzalez, Susanna
Mueller-Edenborn, Bjoern
Bohnen, Marius
Porta-Sanchez, Andreu
Tolosana, Jose Maria
Guasch, Eduard
Roca-Luque, Ivo
Arbelo, Elena
Neumann, Franz-Josef
Westermann, Dirk
Sitges, Marta
Brugada, Josep
Arentz, Thomas
Mont, Lluís
Jadidi, Amir
author_sort Althoff, Till F
collection PubMed
description AIMS: With recurrence rates up to 50% after pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF), predictive tools to improve patient selection are needed. Patient selection based on left atrial late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been proposed previously (UTAH-classification). However, this approach has not been widely established, in part owed to the lack of standardization of the LGE quantification method. We have recently established a standardized LGE-CMR method enabling reproducible LGE-quantification. Here, the ability of this method to predict outcome after PVI was evaluated. METHODS AND RESULTS: This dual-centre study (n = 219) consists of a prospective derivation cohort (n = 37, all persistent AF) and an external validation cohort (n = 182; 66 persistent, 116 paroxysmal AF). All patients received an LGE-CMR prior to first-time PVI-only ablation. LGE was quantified based on the signal-intensity-ratio relative to the blood pool, applying a uniform LGE-defining threshold of >1.2.  In patients with persistent AF in the derivation cohort, left atrial LGE-extent above a cut-off value of 12% was found to best predict relevant low-voltage substrate (≥2 cm two with <0.5 mV during sinus rhythm) and arrhythmia-free survival 12 months post-PVI. When applied to the external validation cohort, this cut-off value was also predictive of arrhythmia-free survival for both, the total cohort and the subgroup with persistent AF (LGE < 12%: 80% and 76%; LGE > 12%: 55% and 44%; P = 0.007 and P = 0.029, respectively). CONCLUSION: This dual-centre study established and validated a standardized, reproducible LGE-CMR method discriminating PVI responders from non-responders, which may improve choice of therapeutic approach or ablation strategy for patients with persistent AF.
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spelling pubmed-98387942023-01-17 Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method Althoff, Till F Eichenlaub, Martin Padilla-Cueto, David Lehrmann, Heiko Garre, Paz Schoechlin, Simon Ferro, Elisenda Invers, Eric Ruile, Philipp Hein, Manuel Schlett, Christopher Figueras i Ventura, Rosa M Prat-Gonzalez, Susanna Mueller-Edenborn, Bjoern Bohnen, Marius Porta-Sanchez, Andreu Tolosana, Jose Maria Guasch, Eduard Roca-Luque, Ivo Arbelo, Elena Neumann, Franz-Josef Westermann, Dirk Sitges, Marta Brugada, Josep Arentz, Thomas Mont, Lluís Jadidi, Amir Eur Heart J Open Original Article AIMS: With recurrence rates up to 50% after pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF), predictive tools to improve patient selection are needed. Patient selection based on left atrial late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been proposed previously (UTAH-classification). However, this approach has not been widely established, in part owed to the lack of standardization of the LGE quantification method. We have recently established a standardized LGE-CMR method enabling reproducible LGE-quantification. Here, the ability of this method to predict outcome after PVI was evaluated. METHODS AND RESULTS: This dual-centre study (n = 219) consists of a prospective derivation cohort (n = 37, all persistent AF) and an external validation cohort (n = 182; 66 persistent, 116 paroxysmal AF). All patients received an LGE-CMR prior to first-time PVI-only ablation. LGE was quantified based on the signal-intensity-ratio relative to the blood pool, applying a uniform LGE-defining threshold of >1.2.  In patients with persistent AF in the derivation cohort, left atrial LGE-extent above a cut-off value of 12% was found to best predict relevant low-voltage substrate (≥2 cm two with <0.5 mV during sinus rhythm) and arrhythmia-free survival 12 months post-PVI. When applied to the external validation cohort, this cut-off value was also predictive of arrhythmia-free survival for both, the total cohort and the subgroup with persistent AF (LGE < 12%: 80% and 76%; LGE > 12%: 55% and 44%; P = 0.007 and P = 0.029, respectively). CONCLUSION: This dual-centre study established and validated a standardized, reproducible LGE-CMR method discriminating PVI responders from non-responders, which may improve choice of therapeutic approach or ablation strategy for patients with persistent AF. Oxford University Press 2022-12-29 /pmc/articles/PMC9838794/ /pubmed/36654964 http://dx.doi.org/10.1093/ehjopen/oeac085 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Althoff, Till F
Eichenlaub, Martin
Padilla-Cueto, David
Lehrmann, Heiko
Garre, Paz
Schoechlin, Simon
Ferro, Elisenda
Invers, Eric
Ruile, Philipp
Hein, Manuel
Schlett, Christopher
Figueras i Ventura, Rosa M
Prat-Gonzalez, Susanna
Mueller-Edenborn, Bjoern
Bohnen, Marius
Porta-Sanchez, Andreu
Tolosana, Jose Maria
Guasch, Eduard
Roca-Luque, Ivo
Arbelo, Elena
Neumann, Franz-Josef
Westermann, Dirk
Sitges, Marta
Brugada, Josep
Arentz, Thomas
Mont, Lluís
Jadidi, Amir
Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method
title Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method
title_full Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method
title_fullStr Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method
title_full_unstemmed Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method
title_short Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method
title_sort predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9838794/
https://www.ncbi.nlm.nih.gov/pubmed/36654964
http://dx.doi.org/10.1093/ehjopen/oeac085
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