Heart rhythm · 2026
CAMERA-MRI score to predict left ventricular ejection fraction normalization post-ablation for primary atrial fibrillation-mediated cardiomyopathy: A pooled analysis of two randomized clinical trials.
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Cho Kenneth K, Segan Louise, Anthony Chris, Nanayakkara Shane, Gutman Sarah, William Jeremy B, Crowley Rose F, D'Elia Nicholas, Chieng David, Sugumar Hariharan, Ling Liang-Han, Voskoboinik Aleksandr, Morton Joseph B, Lee Geoffrey, McLellan Alex J, Lineham Justin, Azzopardi Sonia, Curtin Annie, Rendell Georgia, Kalman Jonathan M, Kistler Peter M, Prabhu Sandeep
Аннотация
BACKGROUND: Primary atrial fibrillation (AF)-mediated cardiomyopathy is a retrospective diagnosis in which left ventricular ejection fraction (LVEF) normalizes following catheter ablation. Identifying prospectively which patients will achieve LVEF normalization remains challenging.
OBJECTIVE: To determine predictors of LVEF normalization in patients with AF-mediated cardiomyopathy following catheter ablation.
METHODS: This was a pooled analysis of the CAMERA-MRI and CAMERA-MRI II multicenter randomized trials, which included baseline and serial cardiac magnetic resonance. This sub-study included all patients who underwent catheter ablation. LVEF normalization predictors were assessed using univariable and multivariable logistic regression. Continuous variables were dichotomized to develop a practical score, internally validated through bootstrap resampling (200 iterations) and 5-fold cross-validation.
RESULTS: 113 patients (mean age, 60.6 ± 11.1 years; 13.3% female; 90.3% persistent AF; baseline LVEF, 31.0% ± 8.7%) were included, and 70 (63.7%) achieved LVEF normalization on serial cardiac magnetic resonance. On multivariable analysis, there were 3 independent predictors: normal indexed LV end-diastolic volume (odds ratio [OR], 3.20; 95% confidence interval [CI], 1.20-8.56; P = .021), absence of alternate etiology (OR, 4.31; 95% CI, 1.14-16.39; P = .023), and absence of late gadolinium enhancement (OR, 2.53; 95% CI, 1.01-6.39; P = .049), with an area under the curve of 0.788 (95% CI, 0.703-0.873). Normalization likelihood by score was 12% (0/3), 38% (1/3), 67% (2/3), and 88% (3/3).
CONCLUSION: Absence of late gadolinium enhancement, normal LV volumes, and absence of an alternative etiology identified that the AF-induced cardiomyopathy phenotype is most likely to achieve LVEF normalization following catheter ablation.
OBJECTIVE: To determine predictors of LVEF normalization in patients with AF-mediated cardiomyopathy following catheter ablation.
METHODS: This was a pooled analysis of the CAMERA-MRI and CAMERA-MRI II multicenter randomized trials, which included baseline and serial cardiac magnetic resonance. This sub-study included all patients who underwent catheter ablation. LVEF normalization predictors were assessed using univariable and multivariable logistic regression. Continuous variables were dichotomized to develop a practical score, internally validated through bootstrap resampling (200 iterations) and 5-fold cross-validation.
RESULTS: 113 patients (mean age, 60.6 ± 11.1 years; 13.3% female; 90.3% persistent AF; baseline LVEF, 31.0% ± 8.7%) were included, and 70 (63.7%) achieved LVEF normalization on serial cardiac magnetic resonance. On multivariable analysis, there were 3 independent predictors: normal indexed LV end-diastolic volume (odds ratio [OR], 3.20; 95% confidence interval [CI], 1.20-8.56; P = .021), absence of alternate etiology (OR, 4.31; 95% CI, 1.14-16.39; P = .023), and absence of late gadolinium enhancement (OR, 2.53; 95% CI, 1.01-6.39; P = .049), with an area under the curve of 0.788 (95% CI, 0.703-0.873). Normalization likelihood by score was 12% (0/3), 38% (1/3), 67% (2/3), and 88% (3/3).
CONCLUSION: Absence of late gadolinium enhancement, normal LV volumes, and absence of an alternative etiology identified that the AF-induced cardiomyopathy phenotype is most likely to achieve LVEF normalization following catheter ablation.