Abstract
Background: Inflammation plays a key role in atrial fibrillation (AF). Epicardial adipose tissue around the atrial wall can influence atrial morpho-functional properties. The aim of this study was to assess whether an increased quantity and/or density of adipose tissue located around the left atrium (Fat-LA) are related to AF, independently from atrial size. Methods: eighty patients who underwent AF ablation and 80 patients without history of AF were selected. The Fat-LA mass was quantified as tissue within −190 to −30 Hounsfield Units (HU) on cardiac computed tomography angiograms (CCTA), and the mean adipose tissue attenuation was assessed. Results: Adipose tissue mass was higher in patients with AF (5.42 ± 2.94 mL) versus non-AF (4.16 ± 2.55 mL, p = 0.007), but relative fat quantity did not differ after adjusting for atrial size. Mean fat density was significantly higher in AF (−69.15 HU) versus non-AF (−76.82 HU, p < 0.0001) participants. In the logistic regression models, only the addition of mean Fat-LA attenuation led to a significant improvement of the model’s chi-square (from 22.89 of the clinical model to 31.69 of the clinical and adipose tissue attenuation model, p < 0.01) and discrimination (AUC from 0.775 to 0.829). Conclusions: Fat-LA volume is significantly greater only in absolute terms in patients with AF, but this difference does not hold after adjusting for the larger LA of AF subjects. On the contrary, a higher Fat-LA density was associated with AF, independently from LA size, providing incremental value over other variables that are associated with AF.
Highlights
Introduction published maps and institutional affilSeveral studies have reported an association between epicardial or pericardial adipose tissue and atrial fibrillation (AF) [1,2], a few of them showing a more specific association between the quantity of fat around the atria and AF [3,4,5,6,7,8]
A recent study assessed the mass of the adipose tissue located posterior to the left atrium (Fat-LA), based on the fat density range measured by cardiac computed tomography angiography (CCTA), and concluded that the mass of Fat-LA is significantly higher in AF patients when compared with patients without AF [6]
Fat mass was not corrected for the left atrium (LA) size in the abovementioned study, which does not permit a conclusion as to whether the higher fat mass in AF patients was due to iations
Summary
Several studies have reported an association between epicardial or pericardial adipose tissue and atrial fibrillation (AF) [1,2], a few of them showing a more specific association between the quantity of fat around the atria and AF [3,4,5,6,7,8]. The proposed pathophysiological mechanisms linking epicardial fat with AF include the possible electric remodeling of the atria by adipose tissue infiltration, fibrosis of the adjacent myocardium or indirect mechanisms, such as adipocytes, which represent a source of atrial myocardial inflammation [8,9]. Fat mass was not corrected for the left atrium (LA) size in the abovementioned study, which does not permit a conclusion as to whether the higher fat mass in AF patients was due to iations.
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