Abstract
BackgroundThis retrospective study was designed to explore the factors relevant to increased atrial 18F-fluorodeoxyglucose (FDG) uptake in patients with atrial fibrillation (AF) who had undergone routine whole-body positron emission tomography/computed tomography (PET/CT) imaging. Methods and ResultsForty-eight consecutive AF patients (32 persistent, 16 paroxysmal) were identified from our routine FDG PET/CT database. Twenty-two control subjects were selected to establish the normal range of FDG uptake (maximum standardized uptake value, SUVmax) in target tissues. A target-to-background ratio (TBR) was calculated to determine abnormal uptake in the atrium and atrial appendage (AA). Univariate comparisons and multivariate regression analyses were conducted to explore the factors associated with the increased FDG accumulation in the atrium and AA. Seventeen AF patients, all with persistent AF, had increased atrial FDG uptake. Most of them (14, or 82.4%) had increased uptake in the right atrium. Eleven AF patients, 9 with persistent AF, had increased uptake in the AA, and bilateral AAs were equally involved. Multivariate logistic regression analyses identified that female gender, persistent AF, and activity in epicardial adipose tissue (EAT) were independent factors predicting the increased activity of the atrium; also, SUVmax of the left ventricle was found for the AA. In addition, multivariate linear regression analyses showed that EAT activity was the only independent variable linearly correlated with the activity of the atrium and AA. ConclusionsAtrial uptake was present in persistent AF and localized mainly in the right atrium, whereas bilateral AAs could be equally involved. Multiple factors contributed to the increased activity in atrium; in particular, the EAT activity was independently correlated with the activity of the atrium and AA.
Highlights
Some case reports and a retrospective study of atrial fibrillation (AF) have found increased uptake of 18Ffluorodeoxyglucose (FDG) in the atria of patients who had undergone whole-body positron emission tomography (PET).[1,2,3,4,5] Under fasting conditions, in which the routine FDG imaging was conducted, physiologic uptake in the myocardium was significantly suppressed and atrial FDG uptake was rarely seen in normal subjects
Atrial uptake was present in persistent AF and localized mainly in the right atrium, whereas bilateral AAs could be involved
We found that abnormal atrial uptake existed only in persistent AF, suggesting that AF induces atrial activity rather than the opposite
Summary
Some case reports and a retrospective study of atrial fibrillation (AF) have found increased uptake of 18Ffluorodeoxyglucose (FDG) in the atria of patients who had undergone whole-body positron emission tomography (PET).[1,2,3,4,5] Under fasting conditions, in which the routine FDG imaging was conducted, physiologic uptake in the myocardium was significantly suppressed and atrial FDG uptake was rarely seen in normal subjects. Intensive studies have shown that activated inflammatory cells exhibit enhanced glucose uptake, which can be detected by FDG imaging.[11] it is reasonable to speculate that the increased atrial uptake of FDG in AF is representative of or associated with inflammation. This retrospective study was designed to explore the factors relevant to increased atrial 18F-fluorodeoxyglucose (FDG) uptake in patients with atrial fibrillation (AF) who had undergone routine whole-body positron emission tomography/computed tomography (PET/CT) imaging
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