Cardiac Adiposity and Arrhythmias: The Role of Imaging

Bonou, Μaria; Mavrogeni, Sophie; Kapelios, Chris J.; Markousis‐Mavrogenis, George; Aggeli, Constantina; Protogerou, Athanase D.; Barbetseas, John

doi:10.3390/diagnostics11020362

Cited by 13 publications

(9 citation statements)

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“…An accumulating body of evidence suggests that EAT is associated with the initiation, perpetuation, and recurrence of AF, especially in case of persistent AF (PersAF) [ 13 , 14 , 15 ]. Quantitative and qualitative evaluation of EAT, aided by the development of imaging techniques, is of growing interest [ 16 ]. The role of EAT in recurrence after PAF catheter ablation has not been clearly elucidated.…”

Section: Introductionmentioning

confidence: 99%

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

Hammache

Pegorer-Sfes²,

Bénali

et al. 2021

JCM

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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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Section: Introductionmentioning

confidence: 99%

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

Hammache

Pegorer-Sfes²,

Bénali

et al. 2021

JCM

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“…Patients with fatty infiltration of the myocardium usually have known cardiomyopathies, myocardial fibrosis, proinflammatory states and poor outcomes [4]. Cardiac steatosis is enhanced in obesity and has been linked to arrhythmogenesis, healed myocardial infarction, genetic disorders, such as arrhythmogenic right ventricular cardiomyopathy, LV diastolic dysfunction and HFpEF [8].…”

Section: Cardiac Steatosis In Hiv (Table 3)mentioning

confidence: 99%

“…Histological and imaging studies have highlighted ectopic cardiac adiposity as an important modulator of accelerated coronary artery atherosclerosis, arrhythmogenesis and HFpEF, due to structural changes in the general population [7,8]. The high‐energy demands of the heart are covered by the oxidation of circulating plasma free fatty acids.…”

Section: Introductionmentioning

confidence: 99%

“…Ectopic fat depots can be visualized by noninvasive screening modalities such as echocardiography, cardiac multidetector computed tomography (CT) and cardiac magnetic resonance (CMR) and have been associated with increased CV risk in the general population [8,11‐13]. Although, EAT and PAT are used to identify different adipose tissues, these terms are often not discriminated on imaging studies.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, magnetic resonance spectroscopy (MRS) is considered the reference standard for the diagnosis of cardiac steatosis; moreover, newer CMR techniques such as multi‐echo Dixon methods, are also useful tools in quantifying myocardial triglyceride content [14,15]. The EAT/PAT thickness and volume have been associated with presence of coronary artery disease, atrial fibrillation, HFpEF and adverse outcomes in the general population [8,16‐18]. In addition, CT‐derived peri‐coronary fat attenuation carries prognostic value in both primary and secondary prevention and offers a significant improvement in CV risk stratification beyond traditional risk factors [19,20].…”

Section: Introductionmentioning

confidence: 99%

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Cardiac adiposity as a modulator of cardiovascular disease in HIV

et al. 2021

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Background With the number of people living with human immunodeficiency virus (HIV) steadily increasing, cardiovascular disease has emerged as a leading cause of non‐HIV related mortality. People living with HIV (PLWH) appear to be at increased risk of coronary artery disease and heart failure (HF), while the underlying mechanism appears to be multifactorial. In the general population, ectopic cardiac adiposity has been highlighted as an important modulator of accelerated coronary artery atherosclerosis, arrhythmogenesis and HF with preserved ejection fraction (HFpEF). Cardiac adiposity is also strongly linked with obesity, especially with visceral adipose tissue accumulation. Aims This review aims to summarize the possible role of cardiac fat depositions, assessed by imaging modalities,as potential contributors to the increased cardiac morbidity and mortality seen in PLWH, as well as therapeutic targets in the current ART era. Materials & Methods Review of contemporary literature on this topic. Discussion Despite antiretroviral therapy (ART), PLWH have evidence of persistent, HIV‐related systemic inflammation and body fat alterations. Cardiac adiposity can play an additional role in the pathogenesis of cardiovascular disease in the HIV setting. Imaging modalities such as echocardiography, cardiac multidetector computed tomography and cardiac magnetic resonance have demonstrated increased adipose tissue. Studies show that high cardiac fat depots play an additive role in promoting coronary artery atherosclerosis and HFpEF in PLWH. Systemic inflammation due to HIV infection, metabolic adverse effects of ART, adipose alterations in the ageing HIV population, inflammation and immune activation are likely important mechanisms for adipose dysfunction and disproportionately occurrence of ectopic fat depots in the heart among PLWH. Conclusions High cardiac adiposity seems to plays an additive role in promoting coronary artery atherosclerosis and HFpEF in PLWH. The underlying mechanisms are multiple and warrant further investigation. Improved understanding of the regulating mechanisms that increase cardiovascular risk in HIV infection may give rise to more tailored therapeutic strategies targeting cardiac fat depots.

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Association of BMI with adherence and outcome in heart failure patients treated with wearable cardioverter defibrillator

Abumayyaleh,

Koepsel,

Erath

et al. 2024

ESC Heart Failure

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BackgroundObesity is a known risk factor for cardiovascular disease (CVD), yet an ‘obesity paradox’ has been observed in various CVD contexts. The impact of obesity on heart failure (HF) patients treated with a wearable cardioverter‐defibrillator (WCD) remains underexplored.MethodsIn a multicentre international registry, we retrospectively collected data from a consecutive series of 1003 patients. These patients were divided into three body mass index (BMI) groups: <25 kg/m2 (n = 348), 25–30 kg/m2 (n = 383), and >30 kg/m2 (n = 272), with BMI > 30 kg/m2 defined as the reference category. Demographics, indications, adherence, WCD shocks, arrhythmic events, rehospitalization due to cardiovascular causes, and mortality were analysed.ResultsAt 3 month follow‐up, patients with a BMI > 30 showed the greatest improvement in left ventricular ejection fraction (LVEF) at 51.4%, significantly higher than the 41.4% in those with a BMI < 25 (P = 0.017) and comparable with the 49.4% in the BMI 25–30 group (P = 0.635). WCD wearing time and adherence were similar across all BMI groups. The incidence of WCD shock was similar across BMI groups. Rates of ventricular tachycardia (VT), ventricular fibrillation and non‐sustained VT (ns‐VT) were comparable across BMI groups. The rate of implantable cardioverter‐defibrillator (ICD) implantation was 40.3% across all patients, with a slightly lower rate in the BMI > 30 group (36.8%) compared with others, although not significantly. Rehospitalization due to cardiovascular causes was significantly lower in the BMI > 30 group (55.4%) compared with the BMI 25–30 group (70.9%; P = 0.048), but similar to the BMI < 25 group (54.9%; P = 0.957). At 2 year follow‐up, mortality was lower in the BMI > 30 group (5.9%) compared with the BMI < 25 (7.5%; P = 0.029) and BMI 25–30 groups (7%; P = 0.681). In multivariable analysis, LVEF at long term was significantly associated with a reduction in mortality.ConclusionsObese patients exhibited significantly greater improvement in LVEF, which was associated with reduced mortality. Adherence to WCD therapy was excellent across all BMI groups. ICD implantation occurred in 40.3% of patients, with similar WCD shock rates and arrhythmic events across BMI groups. An obesity paradox was observed, with obese patients demonstrating significantly lower rehospitalization rates due to cardiovascular causes and reduced mortality at follow‐up.

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Cardiac Adiposity and Arrhythmias: The Role of Imaging

Cited by 13 publications

References 159 publications

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

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

Cardiac adiposity as a modulator of cardiovascular disease in HIV

Association of BMI with adherence and outcome in heart failure patients treated with wearable cardioverter defibrillator

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