Association of Left Atrial Fibrosis Detected by Delayed-Enhancement Magnetic Resonance Imaging and the Risk of Stroke in Patients With Atrial Fibrillation

Abstract

Objectives This study tried to determine the association between left atrial (LA) fibrosis, detected using delayed-enhanced magnetic resonance imaging (DE-MRI), and the CHADS2 score (point system based on individual clinical risk factors including congestive heart failure, hypertension, age, diabetes, and prior stroke) variables, specifically stroke. Background In patients with atrial fibrillation (AF), conventional markers for the risk of stroke base their higher predictive effect on clinical features, particularly previous stroke history, and not individual LA pathophysiological properties. We aimed to determine the association between LA fibrosis, detected using DE-MRI, and the CHADS2 score variables, specifically stroke. Methods Patients with AF who presented to the AF clinic and received a DE-MRI of the LA were evaluated. Their risk factor profiles, including a CHADS2 score, were catalogued. The degree of LA fibrosis was determined as a percentage of the LA area. Any history of previous strokes, warfarin use, or cerebrovascular disease was recorded. Results A total of 387 patients, having a mean age of 65 ± 12 years, 36.8% female, were included in this study. A history of previous stroke was present in 36 (9.3%) patients. Those patients with previous strokes had a significantly higher percentage of LA fibrosis (24.4 ± 12.4% vs. 16.2 ± 9.9%, p < 0.01). A larger amount of LA fibrosis was also seen in those patients with a higher CHADS2 score (≥2: 18.7 ± 11.4 vs. <2: 14.7 ± 9.2, p < 0.01). A logistic regression analysis of all variables except strokes (CHAD score) demonstrated that LA fibrosis independently predicted cerebrovascular events (p = 0.002) and significantly increased the predictive performance of the score (area under the curve = 0.77). Conclusions Our preliminary, multicenter results suggest DE-MRI–based detection of LA fibrosis is independently associated with prior history of strokes. We propose that the amount of DE-MRI–determined LA fibrosis could represent a marker for stroke and a possible therapeutic target with potential applicability for clinical treatment for patients with AF.

Should Patients With Atrial Fibrillation and 1 Stroke Risk Factor (CHA 2 DS 2 -VASc Score 1 in Men, 2 in Women) Be Anticoagulated?

“…38 Fibrosis in the left atrial wall detected by late gadolinium enhancement on magnetic resonance imaging was more pronounced among patients with previous stroke (24.4±12.4% versus 16.1±9.8%; P<0.001) and correlated with CHADS 2 score and the presence of thrombus in the LAA detected by transesophageal echocardiography. 39 These imaging observations contribute to the understanding of the pathophysiology of AF and reinforce the concept that a fibrotic atrial cardiomyopathy is both a cause and a consequence of the dysrhythmia that contributes to the local thrombogenic, inflammatory milieu that links AF with stroke. As progressive cellular metabolic maladaptation extends to the extracellular matrix, the reservoir, conduit, and contractile functions of the thin-walled left atrium deteriorate.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…poziom aktywności, palenie tytoniu, spożycie alkoholu [169,170]), wskaźników strukturalnej przebudowy serca (np. włóknienie [171][172][173] lub elektrokardiograficzne parametry złożoności AF [174]) bądź podłoża genetycznego. W tabeli 6 przedstawiono taką taksonomię opartą na opinii ekspertów [76,120,175], ale nie ma zbyt wielu dowodów potwierdzających zasadność Właściwe rozróżnienie między napadowym a przetrwałym AF często nie jest możliwe bez dostępu do długoterminowego monitorowania [163].…”

Meta-Analysis of CHADS2 versus CHA2DS2-VASc for Predicting Stroke and Thromboembolism in Atrial Fibrillation Patients Independent of Anticoagulation

“…2 The likelihood of an embolic event is closely related to the total points recorded for a given patient, and anticoagulation is advisable for patients with a score of 2 or more points. 7 However, it is unclear whether anticoagulation should be recommended for intermediate-risk patients. When comparing the 2 scoring systems for stratification, investigators have reached different conclusions.…”