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 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

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 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.

scholarly journals Role of epicardial adipose tissue in the development of atrial fibrillation in hypertensive patients

2020 ◽  
Vol 19 (6) ◽  
pp. 2707
Author(s):  
V. I. Podzolkov ◽  
A. I. Tarzimanova ◽  
A. E. Bragina ◽  
K. K. Osadchiy ◽  
R. G. Gataulin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Odds Ratio ◽  
Multislice Computed Tomography ◽  
Comparison Group ◽  
Epicardial Adipose Tissue ◽  
Hypertensive Patients ◽  
Group I

Obesity is a progressing epidemic, the prevalence of which has doubled over the past 30 years. The distribution of adipose tissue is an important factor in predicting the risk of cardiovascular events. The most significant inflammatory activity is characteristic of epicardial adipose tissue (EAT), the role of which in the development of atrial fibrillation (AF) remains a subject of discussion.Aim. To study the effect of EAT size on the development of AF in hypertensive (HTN) patients.Material and methods. The study included 95 patients with HTN aged 38-72 years (mean age, 61,5±1,8 years), including 45 patients with paroxysmal AF (group I) and 50 patients in the comparison group (group II). In order to assess the severity of visceral obesity, all patients underwent a general examination and echocardiography. To determine the EAT volume, cardiac multislice computed tomography was performed.Results. Echocardiography revealed that the EAT thickness was significantly greater in hypertensive patients with paroxysmal AF than in the comparison group: 11,6±0,8 and 8,6±0,4 mm, respectively (p<0,001). According to cardiac multislice computed tomography, a significant increase in EAT volume was revealed in patients of group I (4,6±0,4 ml) compared with group II (3,5±0,25 ml) (p=0,019). In hypertensive patients with paroxysmal AF, a positive moderate relationship between the EAT volume and left atrial volume was revealed (r=0,7, p=0,022). Multivariate analysis showed that in hypertensive patients, EAT thickness >10 mm and volume >6 ml can serve as integral markers of the onset of paroxysmal AF.Conclusion. Integral markers of AF in hypertensive patients are an increase in the EAT thickness >10 mm (odds ratio, 4,1; 95% confidence interval, 1,1-5,6) and volume >6 ml (odds ratio 3,7; 95%, confidence interval 1,0-4,2).

Risk Factors for Developing Peritonitis Caused by Micro-Organisms of Enteral Origin in Peritoneal Dialysis Patients

1998 ◽  
Vol 18 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Francisco Caravaca ◽  
Rosa Ruiz-Calero ◽  
Carmen Dominguez
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Gastric Acid ◽  
Logistic Regression Analysis ◽  
Odds Ratio ◽  
Multiple Logistic Regression Analysis ◽  
Multiple Logistic Regression ◽  
Dialysis Patients

Objective To investigate the risk factors associated with the development of peritonitis caused by enteral bacteria in peritoneal dialysis patients, including the prescription of gastric acid inhibitors as a potential risk factor. Design Retrospective single-center study. Setting Tertiary university hospital. Patients an d Main Outcome Measures Fifty-five patients who entered into our continuous ambulatory peritoneal dialysis (CAPD) program during the last 6 years were included. Multiple logistic regression analysis was used to establish the best determinants over the development of at least one episode of enteric peritonitis. The predictive variables included in the model were: age, gender, diabetic versus nondiabetic, polycystic versus nonpolycystic kidney diseases, history of constipation, presence or absence of moderate/severe malnutrition, peritoneal transport characteristics, peritoneal protein losses, rate of exit-site infections, rate of total peritonitis, intestinal abnormalities, and treatment with inhibitors of gastric acid secretion. Results The total number of peritonitis episodes during the studied period was 88, which clustered in 34 of 55 patients. Fourteen (16%) were caused by enteric microorganisms in 10 patients: Escherichia coli (6), Klebsiella sp (2), Enterobacter sp (1), and Enterococcus sp (5). Nine of 10 patients who developed enteric peritonitis were on gastric acid inhibitors (3 patients on omeprazole and 6 patients on H2-antagonists), while 15 of 45 patients who did not develop enteric peritonitis were on gastric acid inhibitors (all of them on H2-blockers). There were temporal relationships between the start of gastric acid inhibitors and the development of enteric peritonitis in 6 of 9 patients who were on this medication. Four of 10 patients who developed enteric peritonitis had diverticulosis. Ten of 45 patients who did not develop enteric peritonitis had been diagnosed with diverticulosis of the colon or sigmoid prior to entry to CAPD. The unique patient who was not on gastric acid inhibitors and developed enteric peritonitis, had been diagnosed with chronic atrophic gastritis with achlorhydria. By multiple logistic regression analysis, the treatment with gastric acid inhibitors was the only independent variable that entered into the best predictive equation over the development of enteric peritonitis (Iog likelihood ratio = -26.077, odds ratio = 18; 95% CI odds ratio: 2 - 155). Conclusion Gastric acid inhibitors may increase the risk for developing enteric peritonitis in peritoneal dialysis patients.

scholarly journals Potential role of CT-radiomics of epicardial adipose tissue in the prognosis of atrial fibrillation catheter ablation outcome

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
J Ilyushenkova ◽  
AE Shelemekhov ◽  
EV Popov ◽  
SI Sazonova ◽  
RE Batalov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Epicardial Adipose Tissue ◽  
Public Institution ◽  
Slice Thickness ◽  
Tissue Segmentation ◽  
Group 2 ◽  
Af Recurrence ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): None Previous studies have shown that an increase of epicardial adipose tissue (EAT) volume is an independent risk factor of atrial fibrillation (AF) occurrence. However, there is no reliable data about the relationship between EAT and AF recurrence after catheter ablation (CA). Also, there are no studies of the possibility of using of CT radiomics of EAT, in particular of the quantitative assessment of EAT textural changes, for prognosis of CA outcomes in patients with AF.  Thus, the aim of the present study was to estimate the association of CT-radiomics features of EAT with probability of AF recurrence after catheter ablation. Materials and Methods The prospective research included 46 patients (42 males and 4 females, mean age 42.4 ± 9.36) with drug-refractory lone AF referred for catheter ablation (CA). Before CA all patients underwent multislice CT-angiography for preoperative evaluation of cardiac and vessels anatomy and volumes. Images were acquired using a 64-detector CT scanner (GE Discovery NM/CT 570c, GE Healthcare, Milwaukee, WI, USA). Imaging parameters included a gantry rotation time of 400 ms, tube voltage of 120 mA, slice thickness 1.25 mm. For evaluation of EAT only native images (contrast-free scans) without ECG synchronization were analyzed. Epicardial adipose tissue segmentation was performed by 3D-Sliser software and the SliserRadiomics module (version 4.10.2). From CT images we quantified EAT volume and 93 radiomic features, including subgroups of first-order statistics, GLCM, GLDM, GLRLM, GLSZM and NGTDM parameters. All patients were followed-up prospectively for 12 months after the CA. A blanking period of 3 months was applied. The criteria of AF recurrence were AF episodes of more than 30 sec duration. Results. Recurrence of AF was registered in 26 patients. After the end of the follow-up, we divided study population on those with (Group 1) and without (Group 2) AF recurrence. EAT volume and attenuation values for Group 1 were 176.6 ± 56.9 sm3 and -77.47 ± 2.2 HU respectively; for Group 2 were 174.05 ± 73.3 sm3 and -78.42 ± 3.3 HU respectively, with no significant differences (p &lt; 0.05). In the same time, 16 of 93 CT radiomics EAT parameters were significantly different between Group 1 and Group 2 and were significantly associated with AF recurrence after CA according to univariable logistic analyses. Multivariate regression analysis demonstrated that only Gray Level Non-Uniformity Normalized (GLNUN of GLSZM) parameter was an independent predictor of AF recurrence (Odds ratio 1.0022, 95%Cl 1.0006 to 1.0038, p = 0.0013);  ROC-curve analysis data showed that GLNUN &gt; 1227.2 indicates high probability of AF recurrence during 12 months (sensitivity 84.2 %, specificity 70.8 %, AUC:0.765; p = 0.001). Conclusion radiomic biomarkers of EAT have a potential to serve as a predictors of AF recurrence after CA.

scholarly journals Is There an Association between Epicardial Adipose Tissue and Outcomes after Paroxystic Atrial Fibrillation Catheter Ablation?

2021 ◽  
Vol 10 (14) ◽  
pp. 3037
Author(s):  
Néfissa Hammache ◽  
Hugo Pegorer-Sfes ◽  
Karim Benali ◽  
Isabelle Magnin Poull ◽  
Arnaud Olivier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Epicardial Adipose Tissue ◽  
University Hospital ◽  
One Year ◽  
Af Recurrence

Background: In patients undergoing paroxysmal atrial fibrillation (PAF) ablation, pulmonary vein isolation (PVI) alone fails in maintaining sinus rhythm in up to one third of patients after a first catheter ablation. Epicardial adipose tissue (EAT), as an endocrine-active organ, could play a role in the recurrence of AF after catheter ablation. Objective: To evaluate the predictive value of clinical, echocardiographic, biological parameters and epicardial fat density measured by computed tomography scan (CT-scan) on AF recurrence in PAF patients who underwent a first pulmonary vein isolation procedure using radiofrequency (RF). Methods: This monocentric retrospective study included all patients undergoing first-time RF PAF ablation at the Nancy University Hospital between March 2015 and December 2018 with one-year follow-up. Results: 389 patients were included, of whom 128 (32.9%) had AF recurrence at one-year follow-up. Neither total-EAT volume (88.6 ± 37.2 cm3 vs. 91.4 ± 40.5 cm3, p = 0.519), nor total-EAT radiodensity (−98.8 ± 4.1 HU vs. −98.8 ± 3.8 HU, p = 0.892) and left atrium-EAT radiodensity (−93.7 ± 4.3 HU vs. −93.4 ± 6.0 HU, p = 0.556) were significantly associated with AF recurrence after PAF ablation. In multivariate analysis, previous cavo-tricuspid isthmus (CTI) ablation, ablation procedure duration, BNP and triglyceride levels remained independently associated with AF recurrence after catheter ablation at 12-months follow-up. Conclusion: Contrary to persistent AF, EAT parameters are not associated with AF recurrence after paroxysmal AF ablation. Thus, the role of the metabolic atrial substrate in PAF pathophysiology appears less obvious than in persistent AF.

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