Abstract
BackgroundEpicardial adipose tissue (EAT) is associated to atrial fibrillation (AF) burden and outcome after AF ablation. We intended to determine whether global or local EAT is associated with systemic and/or left atrial (LA) inflammation and markers of endothelial dysfunction in AF patients.Methods and ResultsTotal, atrial, and ventricular EAT volume (EATtotal, EATatrial, EATventricular) were measured by multislice cardiac CT in 49 patients with paroxysmal (PAF, n=25) or persistent AF (PeF, n=24). Periatrial epicardial fat thickness at the esophagus (LA-ESO) and thoracic aorta (LA-ThA) were also measured. Vascular endothelial growth factor (VEGF), interleukin-8 (IL-8), soluble intercellular adhesion molecule 1 (sICAM-1), transforming growth factor-β1 (TGF-β1), and von Willebrand Factor (vWF) levels were measured in peripheral and LA blood samples obtained during catheterization during AF ablation. Patients with PeF had higher EATatrial (P<0.05) and LA-ESO (P=0.04) than patients with PAF. VEGF, IL-8, and TGF-β1 were not associated with EAT. In contrast, after adjusting for LA volume and body mass index, higher LA-ThA was significantly associated with higher sICAM-1 and vWF levels, both in peripheral blood (P<0.05) and in LA (P<0.05). Similar results were found with LA-ESO. Body mass index, EATtotal and EATventricular were not associated with sICAM-1 and vWF.ConclusionsPeriatrial epicardial fat showed a significant positive association with increased levels of sICAM-1 and vWF, which are biomarkers of endothelial dysfunction. No such associations were found when considering body mass index or EATtotal. These results suggest that local EAT rather than regional or total adiposity may modulate endothelial dysfunction in patients with AF.
Highlights
Obesity, as measured by body mass index (BMI), is a well known risk factor for atrial fibrillation (AF) initiation [1] and maintenance [2]
Peripheral C-reactive protein (CRP) was significantly lower in patients with paroxysmal AF (PAF), but no significant differences were identified in the other biomarkers according to the type of AF regardless of the site of sampling
We found that the presence of greater amounts of Epicardial adipose tissue (EAT) in contact with the left atrial (LA) was significantly associated with increased levels of soluble intercellular adhesion molecule 1 (sICAM-1) and von Willebrand Factor (vWF) in patients with AF
Summary
As measured by body mass index (BMI), is a well known risk factor for atrial fibrillation (AF) initiation [1] and maintenance [2]. Epicardial adipose tissue (EAT) volume is higher in patients with either paroxysmal AF (PAF) or persistent AF (PeAF) than in controls [3]. Methods and Results: Total, atrial, and ventricular EAT volume (EATtotal, EATatrial, EATventricular) were measured by multislice cardiac CT in 49 patients with paroxysmal (PAF, n=25) or persistent AF (PeF, n=24). Conclusions: Periatrial epicardial fat showed a significant positive association with increased levels of sICAM-1 and vWF, which are biomarkers of endothelial dysfunction. No such associations were found when considering body mass index or EATtotal.
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