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.

中文翻译：

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心房颤动患者的左心房纤维化和脑血管和心血管事件的风险

背景左心房 (LA) 纤维化的严重程度是心房颤动 (AF) 消融成功的有力预测因素，并且与中风、高血压和心力衰竭 (HF) 的病史有关。然而，目前尚不清楚更严重的 LA 纤维化是否会独立增加 AF 患者发生主要不良心脑血管事件 (MACCE) 的风险。目的 本研究的目的是通过 AF 患者 LA 纤维化严重程度的分层来评估 MACCE 的发生率和频率。方法 这是一项回顾性队列研究，纳入 2007 年 1 月至 2015 年 6 月期间接受晚期钆增强 (LGE) 心脏磁共振成像以量化 LA 纤维化严重程度的 1,228 名 AF 患者。 根据 LA LGE 标准的犹他州分期对患者进行分层，以及观察到 MACCE 的发生，其中包括中风或短暂性脑缺血发作 (TIA)、心肌梗塞、急性失代偿性 HF 或心血管死亡的复合。疾病风险评分 (DRS) 分层用于控制基线特征和风险的组间差异。结果 在随访期间，发生了 62 次中风或 TIA、42 次心肌梗塞、156 次 HF 事件和 38 次心血管死亡。在 DRS 分层分析中，对于复合 MACCE 结局，比较 IV 期与 I 期 LA LGE 患者的风险比为 1.67（95% 置信区间：1.01 至 2.76）。在 DRS 分层后，与晚期 LGE 显着相关的 MACCE 结果的唯一单个组成部分是卒中或 TIA（风险比：3.94；95% 置信区间：1.72 至 8.98）。