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A new composite indicator consisting of left ventricular extracellular volume, N-terminal fragment of B-type natriuretic peptide, and left ventricular end-diastolic volume is useful for predicting reverse remodeling after catheter ablation for atrial fibrillation

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Abstract

Recently, myocardial extracellular volume (ECV) analysis has been measurable on computed tomography (CT) using new software. We evaluated the use of cardiac CT to estimate the myocardial ECV of left ventricular (LV) myocardium (LVM) to predict reverse remodeling (RR) in cases of atrial fibrillation (AF) after catheter ablation (CA). Four hundred and seven patients underwent CA for AF in our institution from April 2014 to Feb 2021. Of these, 33 patients (8%) with an LVEF ≤ 50% and who had undergone CT were included in our study. We estimated the LVM ECV using commercial software to analyze the CT data. RR was defined as an improvement in LVEF to > 50% after CA. LVEF increased to > 50% in 24 patients (73%) after CA. In all 24 patients, LVM ECV, LV end-diastolic and end-systolic volumes (LVEDV and LVESV), and the n-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) were significantly lower than in the other nine patients (P = 0.0037, 0.0273, 0.0443, and < 0.0001). On receiver operating characteristic curve analysis, the best cut-off of ECV, LVEDV, LVESV and NT-proBNP for the prediction of RR were 37.73%, 120 mL, 82 mL, and 1267 pg/mL, respectively. We newly defined the ENL (ECV, NT-proBNP, and LVEDV) score as the summed score for the presence or absence (1 or 0; maximum score = 3) of ECV, NT-proBNP, and LVEDV values less than or equal to each best cut-off value, and found that this score gave the highest area under the curve for the prediction of RR (0.9583, P < 0.0001). The ENL score may be useful for predicting RR in patients with AF undergoing CA.

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Acknowledgements

We thank Libby Cone, MD, MA, from DMC Corp. (www.dmed.co.jp <http://www.dmed.co.jp/ >) for editing drafts of this manuscript.

Funding

This work was partially supported by the TSUCHIYA MEMORIAL MEDICAL FOUNDATION (Grant no. J17KF00167).

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, Japan

    Yusei Nishikawa, Hiroyuki Takaoka, Tomonori Kanaeda, Haruhiro Takahira, Sakuramaru Suzuki, Hiroki Goto, Katsuya Suzuki, Satomi Yashima, Manami Takahashi, Makiko Kinoshita, Haruka Sasaki, Noriko Suzuki-Eguchi, Koichi Sano & Yoshio Kobayashi

  2. Department of Cardiology, Eastern Chiba Medical Center, Togane, Japan

    Hiroyuki Takaoka, Shuhei Aoki, Hiroki Goto, Satomi Yashima, Manami Takahashi, Haruka Sasaki & Noriko Suzuki-Eguchi

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  1. Yusei Nishikawa
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Correspondence to Hiroyuki Takaoka.

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Nishikawa, Y., Takaoka, H., Kanaeda, T. et al. A new composite indicator consisting of left ventricular extracellular volume, N-terminal fragment of B-type natriuretic peptide, and left ventricular end-diastolic volume is useful for predicting reverse remodeling after catheter ablation for atrial fibrillation. Heart Vessels 38, 721–730 (2023). https://doi.org/10.1007/s00380-022-02220-x

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