Association of Increased Epicardial Adipose Tissue Thickness With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation

Abstract

The thickness of epicardial adipose tissue (EAT) was reported to be highly associated with the incidence and severity of atrial fibrillation (AF). This study was conducted to analyze the ability of EAT thickness in predicting adverse cardiovascular (CV) events in AF.In 190 persistent AF patients, we performed a comprehensive transthoracic echocardiographic examination with assessment of EAT thickness. The definition of CV events included CV mortality, hospitalization for heart failure, myocardial infarction, and stroke.There were 69 CV events including 19 CV deaths, 32 hospitalizations for heart failure, 3 myocardial infarctions, and 15 strokes during a mean follow-up of 29 (25th–75th percentile: 17–36) months. The multivariable analysis demonstrates that chronic heart failure, increased left ventricular (LV) mass index and the ratio of transmitral E-wave velocity to early diastolic mitral annulus velocity, decreased body mass index, and increased EAT thickness (per 1-mm increase, odds ratio 1.224, 95% confidence interval [CI] 1.096–1.368, P < 0.001) were associated with adverse CV events. Additionally, the addition of EAT thickness to a model containing CHA2DS2-VASc score, left atrial volume index, and LV systolic and diastolic function significantly improved the values in predicting CV events (global χ2 increase 14.65, P < 0.001 and integrated discrimination improvement 0.10, 95% CI 0.04–0.16, P < 0.001).In AF, EAT thickness was useful in predicting adverse CV events. Additionally, EAT thickness could provide incremental value for CV outcome prediction over traditional clinical and echocardiographic parameters in AF.

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

“…The available evidence supports this pathophysiological framework. Epicardial adipose tissue is increased in patients with HFpEF and in those with AF, and is particularly prominent when HFpEF and AF coexist, particularly if patients have evidence of systemic inflammation or are at risk of adverse outcomes . Coronary microvascular dysfunction is exceptionally common in HFpEF and, when present, is associated with a two‐fold increase in the prevalence of AF .…”

Epicardial fat thickness as a tool for predicting complicated obesity

“…В частности, эхокардиографически определяемая ТЭЖ изучалась в качестве предиктора ССО (сердечно-сосудистая смерть, госпитализация по поводу сердечной недо-статочности, инфаркт миокарда, мозговой инсульт) у пациентов с фибрилляцией предсердий (n=190, 67,4% мужчин, средний возраст 70 лет, длительность наблюдения составила в среднем 29 месяцев). По результатам многофакторного анализа, ТЭЖ, превышающая 6 мм (относительный риск 1,211, 95% ДИ 1,084-1,351, р<0,001), была ассоциирована с раз-витием сердечно-сосудистого события, при этом на каждый 1 мм ТЭЖ увеличение риска составило 1,224 (95% ДИ 1,096-1,368, р<0,001) [50].…”

Peri‐atrial epicardial adipose tissue—a marker of thromboembolism?

“…In one such study, an EAT thickness greater than 6 mm was associated with a significant reduction in cardiovascular event‐free survival . In the same study, EAT was also shown to correlate with CHA 2 DS 2 ‐VASc score, although this association appeared to be attenuated with the addition of further covariates . More recently, an increased EAT volume was reported in AF patients who developed stroke, and total EAT was as an independent predictor of excess risk of stroke occurrence after AF diagnosis .…”

“…More recently, preliminary investigations are emerging regarding the possible relationship between visceral fat depots and AF‐related stroke. In one such study, an EAT thickness greater than 6 mm was associated with a significant reduction in cardiovascular event‐free survival . In the same study, EAT was also shown to correlate with CHA 2 DS 2 ‐VASc score, although this association appeared to be attenuated with the addition of further covariates .…”