Epicardial Adipose Tissue and Postoperative Atrial Fibrillation

2021 ◽  
Author(s):  
Petraglia Laura ◽  
Conte Maddalena ◽  
Comentale Giuseppe ◽  
Cabaro Serena ◽  
Campana Pasquale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Epicardial Adipose Tissue ◽  
Perioperative Period ◽  
Postoperative Atrial Fibrillation ◽  
Serum Samples ◽  
Monocyte Chemoattractant Protein 1 ◽  
Elective Cardiac Surgery ◽  
Increased Risk

Abstract Background. Atrial fibrillation (AF) often occurs after cardiac surgery and is associated to increased risk of stroke and mortality. Several evidence support the important role of inflammation in the pathogenesis of postoperative atrial fibrillation (POAF). It is known that an increased volume and a pro-inflammatory phenotype of epicardial adipose tissue (EAT) are both associated with AF onset in non surgical context. In the present study, we aim to evaluate whether also POAF occurrence may be triggered by an exalted production of inflammatory mediators from EAT.Methods. The study population was composed of 105 patients, with no history of paroxysmal or permanent AF, undergoing elective cardiac surgery. After clinical evaluation, all patients performed an echocardiographic study including the measurement of EAT thickness. Serum samples and EAT biopsies were collected before surgery. Levels of 10 inflammatory cytokines were measured in serum and EAT conditioned media. After surgery, cardiac rhythm was monitored for 7 days.Results. Forty-four patients (41.3%) developed POAF. As regard to cardiovascular therapy, only statin use was significantly lower in POAF patients (65.1% vs. 84.7%; p-0.032). Levels of Monocyte Chemoattractant Protein-1 (MCP-1), in both serum and EAT, were significantly higher in POAF patients (130.1 pg/ml vs. 68.7 pg/ml; p = < 0.001; 322.4 pg/ml vs. 153.4 pg/ml; p = 0.028 respectively). EAT levels of IL-6 were significantly increased in POAF patients compared to those in sinus rhythm (126.3 pg/ml vs. 23 pg/ml; p = < 0.005).ConclusionHigher EAT levels of IL6 and MCP1 are significantly associated with the occurrence of POAF. Statin therapy seems to play a role in preventing POAF. These results might pave the way for a targeted use of these drugs in the perioperative period.

scholarly journals Increased Subcutaneous and Epicardial Adipose Tissue Production of Proinflammatory Cytokines in Cardiac Surgery Patients: Possible Role in Postoperative Insulin Resistance

2006 ◽  
Vol 91 (11) ◽  
pp. 4620-4627 ◽  
Author(s):  
Jaromir Kremen ◽  
Marketa Dolinkova ◽  
Jana Krajickova ◽  
Jan Blaha ◽  
Katerina Anderlova ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Mrna Expression ◽  
Proinflammatory Cytokines ◽  
Epicardial Adipose Tissue ◽  
Monocyte Chemoattractant Protein 1 ◽  
Elective Cardiac Surgery ◽  
Tnf Α ◽  
History Of

Abstract Context: Hyperglycemia and insulin resistance frequently occur in critically ill patients even without a history of diabetes. Objective: Our objective was to study the role of adipose tissue hormonal production in the development of insulin resistance in cardiac surgery patients. Participants, Interventions, and Settings: Fifteen patients with elective cardiac surgery underwent blood sampling before, at the end, and 6, 12, 24, 48, and 120 h after the end of their operation. Epicardial and sc adipose tissue sampling was done at the beginning and at the end of surgery in the Department of Cardiac Surgery. Main Outcome Measures: We measured serum concentrations and sc and epicardial adipose tissue mRNA expression of IL-6, monocyte chemoattractant protein-1 (MCP-1), TNF-α, leptin, resistin, and adiponectin and sc and epicardial adipose tissue mRNA expression of CD14, CD45, and CD68. Results: The rate of insulin infusion required to maintain euglycemia increased up to 7-fold 12 h after the operation, suggesting the development of insulin resistance. Serum IL-6 levels increased 43-fold 12 h after surgery. MCP-1 peaked 6-fold at the end of surgery. Smaller peaks of TNF-α and leptin appeared 6 and 12 h after surgery, respectively. Resistin levels peaked 4-fold 24 h after surgery, but adiponectin levels were not significantly affected. TNF-α and CD45 mRNA expression increased markedly during the operation in sc adipose tissue. IL-6, resistin, and MCP-1 mRNA expression increased in both sc and epicardial adipose tissue. Leptin, adiponectin, CD14, and CD68 mRNA expression did not change significantly. Conclusions: Both sc and epicardial adipose tissue is a source of proinflammatory cytokines in cardiac surgery patients and may contribute to the development of postoperative insulin resistance.

Comparison of Rosuvastatin versus Atorvastatin for Preventing Postoperative Atrial Fibrillation

2013 ◽  
Vol 16 (3) ◽  
pp. 158 ◽  
Author(s):  
Okay Abaci ◽  
Cuneyt Kocas ◽  
Veysel Oktay ◽  
Cenk Eray Yildiz ◽  
Kadriye Orta Kilickesmez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Ventricular ◽  
Postoperative Atrial Fibrillation ◽  
Atorvastatin Treatment ◽  
Elective Cardiac Surgery ◽  
Increased Risk ◽  
History Of ◽  
Group 2 ◽  
Group 1

<p><b>Background:</b> Postoperative atrial fibrillation (AF) following cardiac surgery is associated with an increased risk of stroke, prolonged hospitalization, and increased costs. Statin therapy is associated with a lower incidence of postoperative AF. We aimed to compare the preventive effects of rosuvastatin and atorvastatin on postoperative AF.</p><p><b>Methods:</b> This study included 168 patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were divided into 2 groups according to treatment of statin. Group 1 (n = 96) was patients receiving atorvastatin, and group 2 (n = 72) was patients receiving rosuvastatin. Postoperative electrocardiographs (ECGs) and telemetry strips were examined for AF within postoperative period during hospitalization.</p><p><b>Results:</b> The incidences of postoperative AF were 17.9% (n = 17) in group 1 and 22.2% (n = 16) in group 2 (<i>P</i> = .48). Left ventricular end-diastolic diameter (LVEDD) and ejection fraction (EF) were not different between groups. Incidence of diabetes, hypertension, hyperlipidemia, smoking, myocardial infarction in past medical history, family history of atherosclerosis, male sex, drug use, and perioperative features were similar between groups.</p><p><b>Conclusions:</b> The present study revealed that preoperative rosuvastatin or atorvastatin treatment did not have a different effect in preventing postoperative AF.</p>

scholarly journals Does Epicardial Adipose Tissue Influence Postoperative Atrial Fibrillation?

2019 ◽  
Vol 25 (3) ◽  
pp. 149-157 ◽  
Author(s):  
Hiroko Kogo ◽  
Akira Sezai ◽  
Shunji Osaka ◽  
Motomi Shiono ◽  
Masashi Tanaka
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Epicardial Adipose Tissue ◽  
Postoperative Atrial Fibrillation

Improving Incidence of Postoperative Atrial Fibrillation After Cardiac Surgery Using Simplified Clinical Practice Guidelines

2016 ◽  
Vol 33 (8) ◽  
pp. 481-485
Author(s):  
Amr S. Omar ◽  
Hesham Ewila ◽  
Mahmoud Allam ◽  
Sameh Aboulnagah ◽  
Samy Hanoura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Clinical Practice ◽  
Postoperative Atrial Fibrillation ◽  
Early Assessment ◽  
Improvement Project ◽  
Electronic Form ◽  
Increased Risk

Objectives: Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery. Twelve percent patients admitted to this unit postcardiac surgery experienced POAF, which led to hemodynamic instability, increased risk of stroke, and increased length of postoperative intensive care unit stay. Our aim was to decrease the incidence of POAF in the cardiothoracic intensive care unit by the end of April 2014. Methods: Design—Retrospective data analysis. Settings—Postcardiac surgery intensive care in a tertiary hospital. Participants: Postcardiac surgery patients. Intervention—A clinical practice guideline (CPG) was developed to promote early prevention and to improve adherence to POAF prophylaxis recommendations. Patient’s charts were our key performance indicator. Primary outcome measure—Percentage of patients who developed episodes of POAF within the first 24 hours of cardiac surgery. Process measures—compliance with the newly developed CPG and early postoperative patient assessment. Balance measure—early administration of β-blocker. Results: We were able to decrease POAF to 8% after intervention. Compliance with early assessment improved from 25% to 87%. Compliance with adherence to the CPG was 80%. Adherence to the newly developed paper form was the major challenge that could be overcome by an electronic form. We hope to decrease the incidence of POAF to 6% and develop an electronic form by the end of December 2014. Conclusion: This quality improvement project changed the strategy and succeeded in decreasing the incidence of POAF after cardiac surgery. It also improved early assessment of risk factors.

Does the volume of atrial epicardial adipose tissue predict the likelihood of postoperative atrial fibrillation?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
CAJ Van Der Heijden ◽  
JR Olsthoorn ◽  
C Mihl ◽  
S Heuts ◽  
E Bidar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Left Atrial ◽  
Structural Changes ◽  
Epicardial Adipose Tissue ◽  
Left Atrial Volume ◽  
Outcome Data ◽  
Funding Sources ◽  
Custom Made

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Epicardial Adipose Tissue (EAT) is involved in the early pathophysiological process of atrial fibrillation (AF). Its role in the occurrence of post-operative AF (POAF) is less well investigated. The transient occurrence of POAF suggests that surgery-induced triggers unmask a pre-existing AF substrate. Purpose As EAT induces structural changes in the atria, it is interesting to evaluate whether EAT also contributes to the substrate underlying the occurrence of early POAF (&lt;30 days). We hypothesized that patients with high EAT volumes are more likely to develop POAF after cardiac surgery than patients with low EAT volumes. Methods Retrospective quantification of left atrial (LA) EAT was performed on pre-operative coronary computed tomography (CT) angiography scans of patients who underwent cardiac surgery between 2009 and 2017. Patients with a history of AF or with mitral valve disease were excluded, as well as thoracic CT scans. Analysis was based on the Hounsfield Units using custom made software. Results Of the 52 included patients 28 developed POAF. Neither the percentage of EAT in the left atrial (LA) wall nor normalized EAT volumes differed between the POAF and sinus rhythm group (all P &gt; 0.05). After multivariate analysis, age was the only independent predictor for early POAF (OR:1.087 [1.000–1.181]). Conclusion A role for EAT in the occurrence of early POAF was not demonstrated. This might suggest that acute, surgical factors are more important in the onset of early POAF than chronic processes associated with EAT. More and larger trials are needed to confirm these results. EAT-V in the LA wallPOAF (n = 28)SR (n = 24)P-valueEAT-V (ml)0.77 (0.41 - 1.26)0.62 (0.36 - 1.13)0.425MYO-V (ml)3.24 (2.57 - 4.80)2.89 (2.14 - 3.76)0.121% EAT LA wall17.39 ± 8.2418.33 ± 8.400.687EAT-V (ml) / BSA (m&sup2;)0.42 (0.19 - 0.60)0.32 (0.22 - 0.73)1.000EAT-V (ml) / BMI (kg/m&sup2;) (%)2.67 (1.13 - 4.43)2.48 (1.66 - 4.56)0.927EAT-V (ml) / LAVI (ml/m&sup2;) (%)1.92 (1.00 - 4.43)1.51 (1.12 - 2.41)0.583EAT-V (ml) / MYO-V (ml) (%)21.63 (9.54 - 30.18)23.85 (16.75 - 32.79)0.244The percentage of EAT in the LA wall, EAT-V and indexed EAT-V to BSA, BMI, LAVI and MYO-V, based on post-operative rhythm outcome. Data are presented as median (interquartile range) or mean ± standard deviation. EAT-V: epicardial adipose tissue volume; MYO-V; myocardial volume; LA: left atrial; BSA: body surface area; BMI: body mass index; LAVI: left atrial volume index.Abstract Figure. EAT and MYO measurements

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.

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