scholarly journals Epicardial adipose tissue and atrial fibrillation: guilty as charged or guilty by association?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Sousa ◽  
D Matos ◽  
A Ferreira ◽  
J Abecasis ◽  
C Saraiva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Cardiovascular Risk ◽  
Cardiac Ct ◽  
Epicardial Adipose Tissue ◽  
Surrogate Marker ◽  
Epicardial Fat ◽  
The Relationship ◽  
Af Recurrence

Abstract Background Epicardial adipose tissue (EAT) has been linked to the presence and burden of atrial fibrillation (AF). However, it is still unclear whether this relationship is causal or simply a surrogate marker of other risk factors commonly associated with AF. Purpose The purpose of this study was to assess the relationship between these factors and EAT, and to compare their performance in predicting AF recurrence after an ablation procedure. Methods We assessed 575 consecutive patients (mean age 61±11 years, 62% male) undergoing AF ablation preceded by cardiac CT in a high-volume ablation center. EAT was measured on cardiac CT using a modified simplified method. Patients were divided into 2 groups (above vs. below the median EAT volume). Cox regression was used to assess the relationship between epicardial fat, risk factors, and AF relapse. Results Patients with above-median EAT volume were older (p<0.001), more often male (OR 1.7, p=0.002), had higher body mass index, and higher prevalence of smoking, hypertension, diabetes and dyslipidemia (p<0.05). Non-paroxysmal AF was also more common in those with above-median EAT volume. During a median follow-up of 18 months, 232 patients (40.3%) suffered AF recurrence. After adjustment for BMI and other univariate predictors of relapse, three variables emerged independently associated with time to AF recurrence: non-paroxysmal AF (HR 2.1, 95% CI: 1.5–2.7, p<0.001), indexed left atrial (LA) volume (HR 1.006 per mL/m2, 95% CI: 1.002–1.011, p<0.001), and indexed epicardial fat volume (HR 1.87 per mL/m2, 95% CI: 1.66–2.1, p<0.001). None of the classic cardiovascular risk factors were an independent predictor of AF recurrence (all p>0.10). Conclusion Classic cardiovascular risk factors are more prevalent in patients with higher amounts of epicardial fat. However, unlike these risk factors, EAT is a powerful predictor of AF recurrence after ablation. These findings suggest that EAT is not merely a surrogate marker, but an important participant in the pathophysiology of AF. EAT, cvrf and AF burden Funding Acknowledgement Type of funding source: None

scholarly journals Association between Epicardial Adipose Tissue and Recurrence of Atrial Fibrillation after Ablation： A Propensity Score-Matched Analysis

2021 ◽  
Author(s):  
Min Yang ◽  
Wenrui Bao ◽  
Zhihan Xu ◽  
Le Qin ◽  
Ning Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Propensity Score ◽  
Odds Ratio ◽  
Epicardial Adipose Tissue ◽  
Cardiac Computed Tomography ◽  
Multiple Logistic Regression Analysis ◽  
Multiple Logistic Regression ◽  
Af Recurrence

Abstract Purpose: To assess the association between epicardial adipose tissue (EAT) index derived from cardiac computed tomography and atrial fibrillation (AF) recurrence after ablation by comparing with a propensity score matched non-recurrence AF patients.Methods: A total of 506 patients with AF recurrence and 174 patients without AF recurrence were enrolled in this retrospective study. Density and volume of total EAT surrounding the heart (Total-EAT) and EAT surrounding the left atrium（LA-EAT）were measured, propensity score matching(PSM) analyses were used to compare the outcomes of the two groups while controlling for confounders. Results: Total-EAT density (HU) value（-81.27±4.67 vs -84.05±3.84, P=0.000) and LA-EAT density (HU) value（-72.47±23.87 vs -78.83±3.81, P=0.001）were significantly higher in the patients with AF recurrence than in those without recurrence. LA-EAT density (HU) value was significantly higher than Total-EAT（-75.65±17.36 vs -82.66±4.49, P=0.000). In a multiple logistic regression analysis, a higher Total-EAT density (odds ratio: 1.09; 95% CI: 1.00 –1.19, p = 0.047) and LA-EAT density (odds ratio: 1.12; 95% CI: 1.03–1.23, p = 0.012) was significantly associated with the AF recurrence after adjusting for other risk factors. Conclusion: The LA-EAT density plays an important role in the AF recurrence after ablation. Assessment of LA-EAT density can improve ablation outcomes by refining patient selection.

scholarly journals Is Epicardial Adipose Tissue Associated with Atrial Fibrillation Following Cardiac Surgery? A Systematic Review and Meta-Analysis

2021 ◽  
Vol 24 (5) ◽  
pp. E801-E807
Author(s):  
Rina Sha ◽  
Wenqiang Han ◽  
Mingjie Lin ◽  
Jingquan Zhong
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Epicardial Adipose Tissue ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Meta Analyses ◽  
The Relationship ◽  
Af Recurrence

Background: Although epicardial adipose tissue (EAT) has been proven to be related to atrial fibrillation (AF) and post-ablation AF recurrence, the association between EAT and AF after cardiac surgery (AFACS) remains unclear. Objective: This study was a systematic review and meta-analysis that assessed the relationship between EAT and AFACS. Methods: Electronic databases were systematically searched for “atrial fibrillation” and “epicardial adipose tissue.” The analysis was stratified according to the EAT measurement into three meta-analyses as (1) total EAT volume, (2) left atrial (LA)-EAT volume, and (3) EAT thickness. Standardized mean difference (SMD) was estimated using a random effects model. Results: Eight articles with 10 studies (546 patients) were included. The meta-analysis revealed that EAT was higher in those with AFACS irrespective of the EAT measurement (total EAT volume: SMD = 0.56 mL, 95% confidence interval, CI = 0.56–1.10 mL, I2 = 0.90, P = .04; EAT thickness: SMD = 0.85 mm, 95% CI = 0.04–1.65 mm, I2 = 0.90, P = .04; LA-EAT volume: SMD = 0.57 mL, 95% CI = 0.23–0.92 mL, I2 = 0.00, P = .001). Conclusion: EAT was higher in patients with AFACS, measured either as volume or thickness.

Epicardial adipose tissue: the genetics behind an emerging cardiovascular marker

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.A Sousa ◽  
M.G Serrao ◽  
M Temtem ◽  
A Pereira ◽  
M Santos ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Cardiovascular Risk ◽  
Genetic Risk ◽  
Epicardial Adipose Tissue ◽  
Genetic Risk Score ◽  
Renin Angiotensin System ◽  
Epicardial Fat ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Genetic Burden

Abstract Background Increasing evidence points epicardial adipose tissue (EAT) as an emerging cardiovascular risk marker. Whether genetic polymorphisms are associated with a higher EAT burden is still unknow. Genetic risk score (GRS) is an emerging method that attempts to establish correlation between single nucleotide polymorphisms (SNPs) and clinical phenotypes. Aim Evaluate the role of genetic burden and its association to EAT. Methods 996 patients (mean age 59±8, 78% male) were prospectively enrolled in a single center. EAT was measured on cardiac CT using a modified simplified method. Patients were divided into 2 groups (above vs. below the median EAT volume). We studied different polymorphisms across the following gene-regulated pathways: oxidation, renin-angiotensin system, cellular, diabetes/obesity and dyslipidemia pathways. Genotyping was performed by TaqMan allelic discrimination assay. A multiplicative genetic risk score (mGRS) was constructed and represents the genetic burden of the different polymorphisms studied. To evaluate the relation between genetics and EAT volume, we compared both groups by: global mGRS, gene cluster/axis mGRS and individual SNPs. Results Patients with above-median EAT volume were older, had higher body mass index (BMI) and higher prevalence of hypertension, diabetes and dyslipidemia (p<0.05). Patients with higher EAT volumes presented a higher global mean GRS (p<0.001), with the latter remaining an independent predictor for higher EAT volumes (OR 1.3, 95% CI 1.2–1.5), alongside age and BMI. In the analysis by gene clusters, patients with more epicardial fat consistently presented a higher polymorphism burden (translated by a higher mGRS level) across numerous pathways: oxidation, renin-angiotensin system, cellular, diabetes/obesity and dyslipidemia. After adjusting for confounders and other univariate predictors of higher fat volume, the following have emerged as independently related to higher EAT volumes: mGRS comprising the genes of different clusters, age and BMI. Amongst the 33 genes analyzed, only MTHFR677 polymorphisms (a gene with a critical role in regulating plasma homocysteine levels) emerged as significantly related to higher EAT volumes in our population (OR 1.4, 95% CI: 1.100–1.684, p=0.005). Conclusion Patients with a higher polymorphism burden in genes involved in the oxidation, renin-angiotensin, cellular, diabetes/obesity and dyslipidemia pathways present higher levels of epicardial fat. This potential association seems to be independent from the expected association between epicardial fat and cardiovascular risk factors. To our knowledge, this is the first time such genetic profiling has been done, casting further insight into this complex matter. Funding Acknowledgement Type of funding source: None

Abstract 15257: Epicardial and Peri-atrial Fat Attenuation Predict Recurrence in Patients Undergoing Repeat Catheter Ablation for Refractory Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mark S Brahier ◽  
Fengwei Zou ◽  
Frank Migliarese ◽  
Milos Tomovic ◽  
Alexandra Taylor ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Epicardial Fat ◽  
Volume Index ◽  
Atrial Volume ◽  
Af Recurrence

Background: Identifying factors predictive of atrial fibrillation (AF) recurrence after catheter ablation (CA) can improve patient selection. It has been hypothesized that inflammatory paracrine signaling by metabolically active adipose tissue induces pathologic changes in surrounding cardiovascular tissue. In fact, fat attenuation on CT has been previously associated with AF recurrence after de novo CA. The purpose of this study was to investigate the predictive qualities of epicardial and peri-atrial adipose tissue in a population undergoing repeat CA. We hypothesized that higher epicardial and left peri-atrial fat attenuation would predict recurrence as markers of increased localized inflammation. Methods: The study population consisted of 84 patients with symptomatic, drug and ablation-refractory AF undergoing repeat CA. All patients had a pre-ablation, contrast-enhanced cardiac CT, which was analyzed for mean fat attenuation in Hounsfield units (HU) and left atrial volume using the post-processing program 3D Slicer. Patients were followed for recurrence of atrial tachyarrhythmias after a 3-month blanking period. We performed logistic regression to adjust for age, sex, BMI, hypertension, smoking history, diabetes, obstructive sleep apnea, and left atrial volume index. Results: Repeat CA patients with recurrence (n=52) had a higher epicardial fat attenuation (-84.8 ±5.6 vs -88.1 ±5.2 HU; p=0.009) and peri-atrial fat attenuation (-81.0 ±4.7 vs -83.2 ±4.3 HU; p=0.036) than those without recurrence (n=32) at a mean follow-up period of 26 ±18 months. Logistic regression analysis showed that epicardial fat attenuation (OR 1.21; p=0.005) and peri-atrial fat attenuation (OR 1.27; p=0.007) are predictive of AF recurrence independent of traditional risk factors. Conclusions: Epicardial and left peri-atrial adipose attenuation are predictive of recurrence in patients undergoing repeat CA for AF.

P1026Risk factors for the occurrence of stroke after atrial fibrillation ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H E Lim ◽  
J Ahn ◽  
S J Han ◽  
J Shim ◽  
Y H Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Regression Analysis ◽  
Creatinine Clearance ◽  
Clearance Rate ◽  
Epicardial Adipose Tissue ◽  
P Value ◽  
Af Ablation ◽  
Af Recurrence

Abstract Background Risk factors for the occurrence of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated. Our aim was to assess incidence of ES during long-term follow-up following AF ablation and to identify predicting factors associated with post-ablation ES. Methods We enrolled patients who experienced ES after AF ablation and body mass index-matched controls from AF ablation registries. Epicardial adipose tissue (EAT) was assessed using multislice computed tomography prior to ablation. Results A total of 3,464 patients who underwent AF ablation were recruited. During a mean follow-up of 47.2 months, ES occurred in 47 patients (1.36%) with a mean CHA2DS2-VAS score of 2.15 and overall incidence of ES was 0.34 per 100 patients/year. Compared with control group (n=190), ES group had more higher prior thromboembolic event and AF recurrence rates, larger LA size, lower creatinine clearance rate (CCr), and greater total and periatrial EAT volumes although no differences in AF type, CHA2DS2-VASc score, ablation extent, and anti-thrombotics use were found. On multivariate regression analysis, a prior history of thromboembolism, CCr, and periatrial EAT volume were independently associated with ES occurrence after AF ablation. Cox regression analysis Risk factor Univariate Multivariate HR (95% CI) p value HR (95% CI) p value Age 1.017 (0.984–1.051) 0.31 Prior thromboembolism 2.488 (1.134–5.460) 0.023 2.916 (1.178–7.219) 0.021 CHA2DS2-VASc score 1.139 (0.899–1.445) 0.282 CCr 0.984 (0.970–0.999) 0.038 0.982 (0.996–0.998) 0.029 LA diameter (mm) 1.070 (1.012–1.130) 0.017 1.072 (0.999–1.150) 0.054 EAT_total (ml) 1.020 (1.010–1.029) <0.001 1.008 (0.993–1.023) 0.297 EAT_periatrial (ml) 1.085 (1.045–1.126) <0.001 1.065 (1.005–1.128) 0.032 PVI + additional ablation 0.846 (0.460–1.557) 0.592 No anticoagulant use 0.651 (0.346–1.226) 0.184 Recurrence 2.011 (1.007–4.013) 0.048 1.240 (0.551–2.793) 0.603 CCr, creatinine clearance rate; EAT, epicardial adipose tissue; LA, left atrium; PVI, pulmonary vein isolation. K-M curve for stroke-free survival Conclusions Incidence of ES after AF ablation was lower than expected rate based on CHA2DS2-VASc score even though anticoagulants use was limited. Periatrial EAT volume, a prior thromboembolism event, and CCr were independent factors in predicting ES irrespective of AF recurrence and CHA2DS2-VASc score in patients who underwent AF ablation.

scholarly journals Increased epicardial adipose tissue volume is associated with PR interval prolongation

2015 ◽  
Vol 38 (1) ◽  
pp. 45 ◽  
Author(s):  
Wei-Chin Hung ◽  
Wei-Hua Tang ◽  
Chao-Ping Wang ◽  
Li-Fen Lu ◽  
Fu-Mei Chung ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Epicardial Adipose Tissue ◽  
Epicardial Fat ◽  
Interval Prolongation ◽  
Pr Interval ◽  
Qrs Duration ◽  
Adipose Tissue Volume ◽  
Artery Disease ◽  
Visceral Adipose ◽  
The Relationship

Purpose: Epicardial fat is visceral adipose tissue that possesses inflammatory properties. Inflammation and obesity are associated with cardiovascular disease and arrhythmogenesis, but little is known about the relationship between epicardial fat and PR-Interval prolongation. The purpose of this study was to investigate the association between epicardial adipose tissue (EAT) volume and PR-interval prolongation as assessed by computed tomography (CT) and Twelve-lead ECGs. Methods: Patients (n=287) were referred for 64-slice CT for exclusion of coronary artery disease and EAT volumes were determined. Twelve-lead ECGs were obtained from each subject and were evaluated by two independent readers. Results: Patients with significant PR interval prolongation had higher median EAT volume than patients with normal PR interval. Statistically significant correlations were observed between the EAT volume and the PR interval (p = 0.183, p = 0.003), and QRS duration (p = 0.144, p = 0.018). Multivariate and trend analyses confirmed that EAT volume was independently associated with the presence of PR interval prolongation. The receiver operator characteristics curve of EAT volume showed that an EAT volume >144.4 cm³ was associated with PR interval prolongation. Conclusion: This study indicates that EAT volume is highly associated with PR interval prolongation. Whether epicardial fat plays a role in the pathogenesis of PR interval prolongation requires future investigation.

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