Epicardial Adipose Tissue Volume Research Articles

Single-Nucleus Transcriptomic Atlas of Human Pericoronary Epicardial Adipose Tissue in Normal and Pathological Conditions.

Pericoronary epicardial adipose tissue (EAT) is a unique visceral fat depot that surrounds the adventitia of the coronary arteries without any anatomic barrier. Clinical studies have demonstrated the association between EAT volume and increased risks for coronary artery disease (CAD). However, the cellular and molecular mechanisms underlying the association remain elusive. We performed single-nucleus RNA sequencing on pericoronary EAT samples collected from 3 groups of subjects: patients undergoing coronary bypass surgery for severe CAD (n=8), patients with CAD with concomitant type 2 diabetes (n=8), and patients with valvular diseases but without concomitant CAD and type 2 diabetes as the control group (n=8). Comparative analyses were performed among groups, including cellular compositional analysis, cell type-resolved transcriptomic changes, gene coexpression network analysis, and intercellular communication analysis. Immunofluorescence staining was performed to confirm the presence of CAD-associated subclusters. Unsupervised clustering of 73 386 nuclei identified 15 clusters, encompassing all known cell types in the adipose tissue. Distinct subpopulations were identified within primary cell types, including adipocytes, adipose stem and progenitor cells, and macrophages. CD83high macrophages and FOSBhigh adipocytes were significantly expanded in CAD. In comparison to normal controls, both disease groups exhibited dysregulated pathways and altered secretome in the primary cell types. Nevertheless, minimal differences were noted between the disease groups in terms of cellular composition and transcriptome. In addition, our data highlight a potential interplay between dysregulated circadian clock and altered physiological functions in adipocytes of pericoronary EAT. ANXA1 (annexin A1) and SEMA3B (semaphorin 3B) were identified as important adipokines potentially involved in functional changes of pericoronary EAT and CAD pathogenesis. We built a complete single-nucleus transcriptomic atlas of human pericoronary EAT in normal and diseased conditions of CAD. Our study lays the foundation for developing novel therapeutic strategies for treating CAD by targeting and modifying pericoronary EAT functions.

Characteristics of the epicardial adipose tissue measured by low-dose chest computed tomography according to the metabolic health/obesity status

BackgroundEpicardial adipose tissue (EAT) is associated with the development of cardiovascular disease and long-term survival. This study aimed to assess the characteristics of EAT according to the metabolic health and obesity status using low-dose chest computed tomography (CT). MethodsA total of 1074 asymptomatic adults who underwent a medical health check-up were enrolled. Subjects were categorized into the following four groups according to the metabolic health and obesity status: metabolically healthy non-obese (MHNO); metabolically unhealthy non-obese (MUNO); metabolically healthy obese (MHO); and metabolically unhealthy obese (MUO). EAT on low-dose chest CT was measured by using automatic, quantitative measurement software. ResultsMUO showed the highest EAT volume and lowest EAT radiodensity in comparison with MHNO (p < 0.001). The MUNO (n = 70), MHO (n = 259), and MUO (n = 231) groups had increased EAT volume (β [95 % CI], 37.65 [23.11,52.18], 56.79 [47.56,66.02], 84.85 [74.59,95.11] respectively, all p < 0.001), decreased EAT radiodensity (β [95 % CI], − 3.22 [− 4.59,− 1.85], − 4.48 [− 5.30,− 3.66], − 6.03 [− 6.90,− 5.16] respectively, all p < 0.001) in comparison with the MHNO (n = 514) group by using multivariable linear regression models. ConclusionsBoth metabolic abnormalities and obesity were closely associated with EAT characteristics. Characteristics of EAT are similar in MHO and MUNO. This finding suggests that MHO is not a favorable condition in terms of cardiac health, as assessed by the characteristics of EAT. The combination of obesity and metabolically unhealthy status has a synergistic adverse effect on EAT. Measurement of EAT could be a useful imaging biomarker for evaluation of an individual's metabolic health/obesity status.

Higher epicardial adipose tissue volume is associated with higher coronary fatty plaque volume and is regulated by waist circumference but not EPA+DHA supplementation

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation lower triglyceride levels. The impact on epicardial adipose tissue volume (EATV), which is associated with cardiovascular events, is unclear. To determine if triglyceride reduction with EPA+DHA supplementation decreases EATV and whether EATV affects coronary plaque. 139 subjects with coronary artery disease on statins were randomized to 3.36 g EPA+DHA daily or none (control) for 30 months. EATV, coronary plaque volumes and coronary artery calcium score were measured with coronary computed tomographic angiography. Change in triglyceride level correlated with change in EATV (r=0.236; p=0.006). Despite a 6.7% triglyceride reduction (p=0.021) with EPA+DHA supplementation compared to no change in control (between group p=0.034); both groups had similar reductions in EATV possibly due to statin treatment. EATV above the median (>115.6 cm3) was the only determinant of baseline coronary fatty plaque volume (β=2.4, p=0.010). After multivariate adjustment, waist circumference, a surrogate of abdominal visceral adiposity, was the only determinant of baseline EATV (OR:1.093; 95% CI:1.003-1.192, p=0.042). Moreover, increase in waist circumference was the only predictor of an increase in EATV at 30 months (β=0.320, p=0.018). EATV is associated with higher coronary fatty plaque volume and is regulated by waist circumference but not EPA+DHA supplementation at 30-month follow-up in CAD patients on statin treatment. The direct correlation between waist circumference and EATV suggests that maintaining a healthy weight may limit EATV and coronary fatty plaque volume, potentially leading to a decrease in cardiovascular events. Two sentence summary Subjects with clinical CAD on statin treatment randomized to EPA+DHA had similar reductions in epicardial adipose tissue volume (EATV) compared to control, despite a significant reduction in triglyceride level in the EPA+DHA group. Higher EATV was linked to greater fatty, rupture-prone plaques, boosting the risk of MI, and change in waist circumference was the only predictor of an increase in EATV at 30-month follow-up.

Changes in Epicardial Adipose Tissue Assessed by Chest CT in Breast Cancer Patients Receiving Adjuvant Chemotherapy with Anthracyclines and Trastuzumab.

Cardiotoxicity (CTX) induced by adjuvant chemotherapy is a significant factor that impacts the prognosis and quality of life in breast cancer (BC) patients. In this study, we aimed to investigate the changes in epicardial adipose tissue (EAT) before and after treatment in BC patients who received anthracyclines adjuvant chemotherapy protocol (AC-T) and anthracyclines combined with trastuzumabadjuvant chemotherapy protocol (AC-TH). Additionally, we assessed whether there were any differences in the changes in EAT between the two groups of patients. Our objective was to examine the effects of anthracyclines and trastuzumab on EAT and determine the potential role of EAT changes on CTX. We reviewed female BC patients who were treated with adjuvant chemotherapy protocols of AC-T and AC-TH, all of whom underwent baseline (T0) and follow-up (T1) chest computed tomography (CT) and echocardiography. A cohort of healthy women, matched in age, underwent two chest CTs. EAT was quantified on chest CT using semi-automated software. CTX was defined as a 10% reduction in left ventricular ejection fraction (LVEF) from baseline, with an absolute value of 53%. A total of 41 BC patients were included in the study, with 23 patients in the AC-T group and 18 patients in the AC-TH group. Additionally, 22 healthy females were included as the normal group. None of the BC patients developed CTX after chemotherapy. The age did not differ significantly between the normal group and the AC-T group (p = 0.341) or the AC-TH group (p = 0.853). Similarly, the body mass index (BMI) of the normal group was comparable to that of the AC-T group (p = 0.377, 0.346) and the AC-TH group (p = 0.148, 0.119) before and after chemotherapy. The EAT volume index (mL/kg/ ) was significantly higher in both the AC-T group (5.11 1.85 vs. 4.34 1.55, p 0.001) and the AC-TH group (4.53 1.61 vs. 3.48 1.62, p 0.001) at T1 compared with T0. In addition, both the AC-T group (-72.95 5.01 vs. -71.22 3.91, p = 0.005) and the AC-TH group (-72.55 5.27 vs. -68.20 5.98, p 0.001) exhibited a significant decrease in EAT radiodensity (HU) at T1 compared to T0. However, there was no significant difference observed in the normal group. At T0, no difference was seen in EAT volume index (4.34 1.55 vs. 3.48 1.62, p = 0.090) and radiodensity (-71.22 3.91 vs. -68.20 5.98, p = 0.059) between the AC-T and AC-TH groups. Similarly, at T1, there was still no significant difference observed in the EAT volume index (-5.11 1.85 vs. 4.53 1.61, p = 0.308) and radiodensity (-72.95 5.00 vs. -72.54 5.27, p = 0.802) between the two groups. BC patients who underwent AC-T and AC-TH adjuvant chemotherapy protocols demonstrated a significant rise in the volume index of EAT, along with a substantial reduction in its radiodensity post-chemotherapy. These findings indicate that alterations in EAT could potentially aid in identifying cardiac complications caused by chemotherapeutic agents and remind clinicians to focus on changes in EAT after adjuvant chemotherapy in BC patients to prevent the practical occurrence of CTX.

Relationship Between Epicardial Adipose Tissue Volume and Recurrence After Ablation in Premature Ventricular Complexes.

Epicardial adipose tissue (EAT) is recognized as a clinical diagnostic marker for cardiometabolic disease. Thicker EAT may be associated with recurrence of ventricular tachycardia after ablation. The association between EAT volume and recurrence of premature ventricular complexes (PVC) following ablation has not been clarified. We investigated the association between EAT volume and PVC recurrence following radiofrequency catheter ablation.Methods and Results: This retrospective study included 401 patients with PVC undergoing catheter ablation with preprocedural non-contrast computed tomography between 2017 and 2022. The impact of EAT volume in predicting PVC recurrence after ablation was analyzed. The mean (±SD) age of patients was 50.2±13.3 years. Multivariable Cox analysis revealed that a large EAT volume was an independent predictor of PVC recurrence after ablation during a median follow-up of 16.3 months. Kaplan-Meier analysis showed a difference in postablation PVC recurrence between the 2 groups dichotomized around the EAT volume cut-off. The risk of recurrence increased with increasing EAT volume according to restricted cubic spline regression. Furthermore, PVC originating from epicardial locations had larger EAT volumes than those originating from the right ventricular outflow tract. A large EAT volume was independently associated with PVC recurrence following ablation. Patients with PVC originating from epicardial sites had large EAT volumes. EAT volume may help stratify patients according to their risk of PVC recurrence after ablation.

Feasibility of Auto-Quantified Epicardial Adipose Tissue in Predicting Atrial Fibrillation Recurrence After Catheter Ablation.

The aim of this study was to build an auto-segmented artificial intelligence model of the atria and epicardial adipose tissue (EAT) on computed tomography (CT) images, and examine the prognostic significance of auto-quantified left atrium (LA) and EAT volumes for AF.Methods and Results: This retrospective study included 334 patients with AF who were referred for catheter ablation (CA) between 2015 and 2017. Atria and EAT volumes were auto-quantified using a pre-trained 3-dimensional (3D) U-Net model from pre-ablation CT images. After adjusting for factors associated with AF, Cox regression analysis was used to examine predictors of AF recurrence. The mean (±SD) age of patients was 56±11 years; 251 (75%) were men, and 79 (24%) had non-paroxysmal AF. Over 2 years of follow-up, 139 (42%) patients experienced recurrence. Diabetes, non-paroxysmal AF, non-pulmonary vein triggers, mitral line ablation, and larger LA, right atrium, and EAT volume indices were linked to increased hazards of AF recurrence. After multivariate adjustment, non-paroxysmal AF (hazard ratio [HR] 0.6; 95% confidence interval [CI] 0.4-0.8; P=0.003) and larger LA-EAT volume index (HR 1.1; 95% CI 1.0-1.2; P=0.009) remained independent predictors of AF recurrence. LA-EAT volume measured using the auto-quantified 3D U-Net model is feasible for predicting AF recurrence after CA, regardless of AF type.

Association of epicardial fat with cardiac structure and function and exercise capacity in heart failure with preserved ejection fraction: A systematic review and meta-analysis

BackgroundStudies have reported the association of epicardial adipose tissue (EAT) with cardiac structure and function as well as exercise capacity in patients with heart failure with preserved ejection fraction (HFpEF), yielding inconsistent results. We aimed to conduct a meta-analysis of studies on the association of EAT with cardiac structure and function and exercise capacity in HFpEF patients. Methods and ResultsWe searched studies examining the association of EAT quantified by echocardiography, computed tomography, or magnetic resonance imaging (MRI) with cardiac structure and function or exercise capacity in HFpEF patients through PubMed, Web of Science, and Scopus. In cases of significant heterogeneity (I2 > 50 %), data were pooled using a random-effects model; otherwise, a fixed-effects model was used. We identified five echocardiography studies (n = 825) and six MRI studies (n = 562), but found no computed tomography studies. In the echocardiography studies, EAT thickness correlated positively with left ventricular (LV) mass (Prandom < 0.01) and negatively with LV global longitudinal strain (Prandom < 0.01) and peak exercise oxygen uptake (Pfix < 0.001). In the MRI studies, EAT volume correlated positively with LV mass (Pfix < 0.01), left atrial volume (Pfix < 0.001), and the ratio of LV early diastolic mitral inflow to early diastolic mitral annular velocity (E/e’; Prandom < 0.01) and negatively with LV ejection fraction (Pfix < 0.01) and LV global longitudinal strain (Pfix < 0.001). ConclusionOur meta-analysis indicates a potential association of increased EAT with altered cardiac structure and function and exercise intolerance in HFpEF patients. However, our meta-analysis included only two or three studies for each outcome and thus further studies are necessary to confirm our findings.

Increased epicardial adipose tissue is associated with left atrial mechanical dysfunction in patients with heart failure with mildly reduced and preserved ejection fraction.

Heart failure (HF) with mildly reduced and preserved ejection fraction (HFmrEF/HFpEF) is often accompanied by atrial dysfunction. It has been suggested that specific ectopic fat depots, such as epicardial adipose tissue (EAT), may directly influence the myocardial cells and, therefore, be involved in the pathophysiology of atrial mechanical dysfunction. In this study, we aimed to investigate the association between EAT and left atrial (LA) mechanical dysfunction. In total, 82 patients with symptomatic HF and left ventricular ejection fraction > 40% were prospectively enrolled. All patients underwent CMR while in sinus rhythm. LA mechanical dysfunction was defined as the presence of LA end-systolic volume index > 52mL/m2 and LA reservoir strain < 23%. EAT volume was indexed for body surface area. Mean age was 69 ± 10years, 42 (51%) were women and mean body mass index (BMI) was 29 ± 6kg/m2. Mean LVEF was 55 ± 9% and 34 (41%) patients had LA mechanical dysfunction. In patients with LA mechanical dysfunction, the EAT volume was significantly higher than in patients without LA mechanical dysfunction (90 vs 105mL/m2, p = 0.02) while BMI was similar. In multivariable logistic regression analyses, increased EAT remained significantly associated with LA mechanical dysfunction (OR 1.31, 95% CI 1.03-1.66, p = 0.03). Increased EAT was associated with LA mechanical dysfunction in patients with HFmrEF and HFpEF. Further research is needed to elucidate the exact mechanisms that underlie this association.

Impact of restoration of sinus rhythm after catheter ablation of atrial fibrillation on reverse cardiac remodelling

Abstract Introduction Catheter ablation (CA) with pulmonary vein isolation (PVI) has become widely used for the treatment of atrial fibrillation (AF). Restoration of sinus rhythm in patients with AF is of vital importance, because AF induces the development of heart failure (HF) through various pathophysiological mechanisms, one of them is epicardial adipose tissue (EAT). EAT is a type of visceral adipose tissue that is in direct contact with the myocardium. Under pathological conditions it serves as a direct and indirect factor in pathogenesis of AF. It is also an established prognostic factor after CA of AF recurrence. Since cardiac magnetic resonance (CMR) represent the gold standard for the measurement of volume and muscle mass, it has been used more and more for the assessment of EAT volume lately. Purpose The aim of our study was to investigate the impact of restoration of sinus rhythm on EAT volume, and cardiac function and morphology evaluated by the CMR. Methods We prospectively included 17 patients with paroxysmal and persistent AF that were referred for CA. All patients underwent cardiac magnetic CMR prior to radiofrequency CA with PVI and 6 months thereafter in order to quantify periatrial EAT volumes and evaluate cardiac morphological and functional characteristics. AF recurrence rate was diagnosed by serial ECG recordings, Holter ECG monitoring and AF suggestive symptoms within 6 months of follow-up period. Results 17 patients, mainly male (76.5 %) with an average age of 62.35 ± 12.10 years were included in our study. The average body mass index (BMI) was 29.0 ± 4.71 kg/m2. Most patients had paroxysmal AF prior to CA (88.2 %). The recurrence rate of AF was 35.3 % after 6 months of follow-up. By performing CMR after 6 months of CA we observed lower median periatrial EAT volume (36.00 mL (IQR 38.25 mL) vs. 27.45 mL (IQR 30.94 mL); p= 0.004) and lower median left ventricular mass (LVM) (104.0 g/m2 (IQR 38 g/m2) vs. 100.0 g/m2 (IQR 42 g/m2); p= 0.019). Furthermore, when patients were stratified based on the AF status after the follow-up period, we observed that the patients who remained AF-free had significantly lower median periatrial EAT volumes (38.90 mL (IQR 43.84 mL) vs. 26.83 mL (IQR 33.25 mL); p= 0.003) and median LVM (96 g/m2 (IQR 35 g/m2) vs. 90 g/m2 (IQR 29.8 g/m2); p= 0.041) compared to the group of patients who relapsed where we did not observe a significant change in periatrial EAT volume (23.76 mL (IQR 26.84 mL) vs. 31.28 mL (IQR 27.84); p= 0.345) or LVM (117.5 g/m2 (IQR 34 g/m2) vs. 112 g/m2 (IQR 28.6 g/m2); p= 1.0). Significant correlation was observed between BMI and periatrial EAT volume (p= 0.029). Conclusions Restoration of sinus rhythm after CA of AF is associated to lower periatrial EAT volume and LVM. Patients who relapsed did not show reverse cardiac remodelling. Periatrial EAT volume significantly correlates with BMI.

Associations between atrial epicardial fat quantified by semi-automated CT segmentation and gender, BMI, cholesterol levels in AF patients: results from the prospective AFAT study

Abstract Background Epicardial adipose tissue (EAT) is defined as adipose tissue (epicardial fat) between the myocardium and the visceral pericardium. Recent evidence suggests that EAT may play important roles in regard to atrial fibrillation (AF) burden as well as other cardiovascular diseases through complex inflammatory mechanisms. Current evidence regarding the relationship of atrial EAT and BMI, gender or cardiovascular risk factors is mixed. Methods and Results We conducted a prospective observational study (AFAT) at the German Heart centre in Munich with 200 patients aimed to be included. This represents an interim analysis of the first 75 patients enrolled in the AFAT study. All patients received delayed dual source cardiac computer tomography (CT) imaging which was analysed using 3D segmentation (Figure 1) to quantify left atrial (LA) and right atrial (RA) EAT prior to receiving catheter ablation for AF. The mean age was 67 ± 8.7 years with 46.9 % being female (n=35) and the mean BMI was 28 ± 4.5. Mean LA EAT was 33.1 ml ± 13.2 ml and RA EAT was 32.7 ml ± 12.2ml with a total mean atrial EAT volume of 65.4 ml ± 10.2 ml. Volumes of the left- and right atrial EAT were significantly correlated in our sample (p &amp;lt; 0.001; Pearson correlation coefficient r=0.9). The mean total EAT Volume was significantly larger in males than in females (74 ml vs. 52 ml, p &amp;lt; 0.001) (Figure 2). Linear regression analysis adjusted for cofounders demonstrated significantly larger mean atrial EAT volumes in patients with higher body mass index (p = 0.001) and with increased age (p=0.006). Increased HbA1c levels or increased total cholesterol levels were not associated with higher total atrial EAT Levels (respectively, p=0.066 and p=0.22). Conclusion Semi-automated CT based atrial segmentation is a novel highly accurate and reproducible way to reliably identify atrial EAT. Left and right atrial EAT volumes are significantly intercorrelated. In this study BMI, Age and male gender were independently associated with higher EAT levels.Visualization of atrial EATGender differences in atrial EAT (ml)

Relationship Between Clinical Parameters and Histological Features of Epicardial Adipose Tissue and Aortic Valve Calcification Assessed on Computed Tomography.

The relationships of the clinical and biological attributes of epicardial adipose tissue (EAT) with aortic valve calcification (AVC) have not been characterized. We evaluated the relationships of the clinical and histological features of EAT with AVC assessed using computed tomography (CT).Methods and Results: We enrolled 43 patients undergoing cardiac CT examination prior to elective cardiac surgery in whom AVC was identified on CT. EAT volume and density, coronary calcium score (CCS), AVC score (AVCS), and coronary atherosclerosis on CT angiography were evaluated in each patient. During cardiac surgery, 2 EAT samples were obtained for immunohistochemistry. The number of CD68- and CD11c-positive macrophages and osteocalcin-positive cells was counted in 6 random high-power fields of EAT sections. EAT density, but not EAT volume normalized to body surface area, was positively correlated with the number of macrophages and osteocalcin-positive cells in EAT. There was a positive correlation between ln(AVCS), but not ln(CCS+1), and the number of macrophages and osteocalcin-positive cells in EAT. Multivariate analysis revealed significant positive correlations for ln(AVCS) with EAT density (β=0.42; P=0.0072) and the number of CD68-positive macrophages (β=0.57; P=0.0022), CD11c-positive macrophages (β=0.62; P=0.0003), and osteocalcin-positive cells (β=0.52; P=0.0021) in EAT. Inflammation and osteogenesis in EAT, reflected by high CT density, are associated with the severity of AVC representing aortic valve degeneration.

Association of epicardial adipose tissue volume with heart weight in post-mortem cases.

Epicardial adipose tissue (EAT) deposition has been long associated with heart weight. However, recent research has failed to replicate this association. We aimed to determine the association of EAT volume with heart weight in post-mortem cases and identify potential confounding variables. EAT volume derived from post-mortem computed tomography (PMCT) and heart weight were measured in post-mortem cases (N = 87, age: 56 ± 16years, 28% female). Cases with hypertrophied heart weights (N = 44) were determined from reference tables. Univariable associations were tested using Spearman correlation and simple linear regression. Independence was determined with stepwise regression. In the total cohort, EAT volume (median 66 ± 45 cm3) was positively associated with heart weight (median 435 ± 132g) at the univariable level (r = 0.6, P < 0.0001) and after adjustment for age, female sex, and various body size metrics (R2 adjusted = 0.41-0.57). Median EAT volume was 1.9-fold greater in cases with hypertrophic hearts (P < 0.0001) but with considerably greater variability, especially in cases with extreme EAT volume or heart weight. As such, EAT volume was not associated with heart weight in hypertrophic cases, while a robust independent association was found in non-hypertrophic cases (R2 adjusted = 0.62-0.86). EAT mass estimated from EAT volume found that EAT comprised approximately 13% of overall heart mass in the total cases. This was significantly greater in cases with hypertrophy (median 15.5%; range, 3.6-36.6%) relative to non-hypertrophied cases (12.5%, 3.3-24.3%) (P = 0.04). EAT volume is independently and positively associated with heart weight in post-mortem cases. Excessive heart weight significantly confounded this association.

Epicardial Atrial Fat at Cardiac Magnetic Resonance Imaging and AF Recurrence after Transcatheter Ablation.

The relationship between epicardial adipose tissue (EAT) and atrial fibrillation (AF) has gained interest in recent years. The previous literature on the topic presents great heterogeneity, focusing especially on computed tomography imaging. The aim of the present study is to determine whether an increased volume of left atrial (LA) EAT evaluated at routine pre-procedural cardiac magnetic resonance imaging (MRI) relates to AF recurrences after catheter ablation. A total of 50 patients undergoing AF cryoballoon ablation and pre-procedural cardiac MRI allowing quantification of LA EAT were enrolled. In one patient, the segmentation of LA EAT could not be achieved. After a median follow-up of 16.0 months, AF recurrences occurred in 17 patients (34%). The absolute volume of EAT was not different in patients with and without AF recurrences (10.35 mL vs. 10.29 mL; p-value = 0.963), whereas the volume of EAT indexed on the LA volume (EATi) was lower, albeit non-statistically significant, in patients free from arrhythmias (12.77% vs. 14.06%; p-value = 0.467). The receiver operating characteristic curve testing the ability of LA EATi to predict AF recurrence after catheter ablation showed sub-optimal performance (AUC: 0.588). The finest identified cut-off of LA EATi was 10.65%, achieving a sensitivity of 0.5, a specificity of 0.82, a positive predictive value of 0.59 and a negative predictive value of 0.76. Patients with values of LA EATi lower than 10.65% showed greater survival, free from arrhythmias, than patients with values above this cut-off (84% vs. 48%; p-value = 0.04). In conclusion, EAT volume indexed on the LA volume evaluated at cardiac MRI emerges as a possible independent predictor of arrhythmia recurrence after AF cryoballoon ablation. Nevertheless, prospective studies are needed to confirm this finding and eventually sustain routine EAT evaluation in the management of patients undergoing AF catheter ablation.

Epicardial adipose tissue volume assessed by cardiac CT as a predictor of atrial fibrillation recurrence following catheter ablation

IntroductionIn patients with atrial fibrillation (AF), up to one third have recurrence after a first catheter ablation (CA). Epicardial adipose tissue (EAT) has been considered to be closely related to AF, with a potential role in its recurrence. We aimed to evaluate the association between the volume of EAT measured by cardiac computed tomography (CT) and AF recurrence after CA. MethodsConsecutive AF patients underwent a standardized cardiac CT protocol for quantification of EAT, thoracic adipose volume (TAV) and left atrium (LA) volume before CA. An appropriate cut-off of EAT was determined and risk recurrence was estimated. Results305 patients (63.6 % male, mean age 57.5 years, 28.2 % persistent AF) were followed for 24 months; 23 % had AF recurrence at 2-year mark, which was associated with higher EAT (p = 0.037) and LAV (p < 0.001). Persistent AF was associated with higher EAT volumes (p = 0.010), TAV (p = 0.003) and LA volumes (p < 0.001). EAT was predictive of AF recurrence (p = 0.044). After determining a cut-off of 92 cm3, survival analysis revealed that EAT volumes > 92 cm3 showed higher recurrence rates at earlier time points after the index ablation procedure (p = 0.006), with a HR of 1.95 (p = 0.008) of AF recurrence at 2-year. After multivariate adjustment, EAT > 92 cm3 remained predictive of AF recurrence (p = 0.028). ConclusionThe volume of EAT measured by cardiac CT can predict recurrence of AF after ablation, with a volume above 92 cm3 yielding almost twice the risk of arrhythmia recurrence in the first two years following CA. Higher EAT and TAV are also associated with persistent AF.

Epicardial adipose tissue (EAT) thickness on non-gated chest CT as an alternative to EAT volume on cardiac CT.

Epicardial adipose tissue (EAT) volume is usually measured with ECG-gated computed tomography (CT). Measurement of EAT thickness is a more convenient method; however, it is not clear whether EAT thickness measured with non-gated CT is reliable and at which localization it agrees best with the EAT volume. To examine the agreement between ECG-gated EAT volume and non-gated EAT thickness measured from various localizations and to assess the predictive role of EAT thickness for high EAT volume. EAT thickness was measured at six locations using non-contrast thorax CT and EAT volume was measured using ECG-gated cardiac CT (n = 68). The correlation and agreement (Bland-Altman plots) between the thicknesses and EAT volume were assessed. EAT thicknesses were significantly correlated with EAT volume (P < 0.001). The highest correlation (r = 0.860) and agreement were observed for the thickness adjacent to the right ventricular free wall. Also, EAT thickness at this location has a strong potential for discriminating high (>125 cm3) EAT volume (area under the ROC curve=0.889, 95% CI=0.801-0.977; P < 0.001). The sensitivity, specificity, and positive and negative predictive values of EAT thickness for high EAT volume were 76.5%, 88.2%, 68.4%, and 91.8%, respectively, for the cutoff value of 5.75 cm; and 47.1%, 100%, 100%, and 85%, respectively, for the cutoff value of 8.10 cm. EAT thickness measured on non-gated chest CT adjacent to the right ventricular free wall is a reliable and easy-to-use alternative to the volumetric quantification and has a strong potential to predict high EAT volume.

DEep LearnIng-based QuaNtification of epicardial adipose tissue predicts MACE in patients undergoing stress CMR

Background and aimsThis study investigated the additional prognostic value of epicardial adipose tissue (EAT) volume for major adverse cardiovascular events (MACE) in patients undergoing stress cardiac magnetic resonance (CMR) imaging. Methods730 consecutive patients [mean age: 63 ± 10 years; 616 men] who underwent stress CMR for known or suspected coronary artery disease were randomly divided into derivation (n = 365) and validation (n = 365) cohorts. MACE was defined as non-fatal myocardial infarction and cardiac deaths. A deep learning algorithm was developed and trained to quantify EAT volume from CMR. EAT volume was adjusted for height (EAT volume index). A composite CMR-based risk score by Cox analysis of the risk of MACE was created. ResultsIn the derivation cohort, 32 patients (8.7 %) developed MACE during a follow-up of 2103 days. Left ventricular ejection fraction (LVEF) < 35 % (HR 4.407 [95 % CI 1.903–10.202]; p<0.001), stress perfusion defect (HR 3.550 [95 % CI 1.765–7.138]; p<0.001), late gadolinium enhancement (LGE) (HR 4.428 [95%CI 1.822–10.759]; p = 0.001) and EAT volume index (HR 1.082 [95 % CI 1.045–1.120]; p<0.001) were independent predictors of MACE. In a multivariate Cox regression analysis, adding EAT volume index to a composite risk score including LVEF, stress perfusion defect and LGE provided additional value in MACE prediction, with a net reclassification improvement of 0.683 (95%CI, 0.336–1.03; p<0.001). The combined evaluation of risk score and EAT volume index showed a higher Harrel C statistic as compared to risk score (0.85 vs. 0.76; p<0.001) and EAT volume index alone (0.85 vs.0.74; p<0.001). These findings were confirmed in the validation cohort. ConclusionsIn patients with clinically indicated stress CMR, fully automated EAT volume measured by deep learning can provide additional prognostic information on top of standard clinical and imaging parameters.

Contribution of epicardial adipose tissue to atrial fibrillation development in patients with arterial hypertension: a pilot study

Aim. To evaluate the value of body mass index (BMI), visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) depots in the development of atrial fibrillation (AF).Material and methods. The study included 24 people with isolated hypertension (HTN) and 28 people with HTN in combination with AF. The median age of patients was 61,5 [53,8;69,0] years. The observational study assessed height, weight, BMI, proportion of VAT, EAT thickness, and cardiac chamber sizes. Height was measured using a metal height meter Rm-1 "Diakoms"; the results were expressed in centimeters. Weight, BMI, and VAT proportion were measured using an Omron BF-508 body composition monitor (Omron, Japan). EAT thickness and cardiac chamber sizes were assessed using two-dimensional echocardiography. Univariate logistic regression models were used to assess the independent contribution of the identified factors associated with the disease presence.Results. Hypertensive patients with and without AF were comparable in terms of BMI and VAT content. At the same time, the EAT content was significantly higher in the group of patients with HTN and AF and amounted to 7,0 [5,0;8,2] mm and 6,0 [4,5;7,0] mm (p=0,027) in the group HTN with and without AF, respectively.Left atrial (LA) volume was 70 [55,2;83,0] ml and 52 [45,5;59,0] ml (p=0,003) in the hypertensive group with and without AF, respectively. Univariate analysis revealed the greatest significance of EAT and LA volume in terms of AF prediction. Logistic regression models did not reveal significant effect of VAT.Conclusion. In hypertensive patients with and without AF at comparable levels of BMI and VAT, differences in EAT thickness and LA volume were identified. Univariate analysis showed that these factors have an advantage in the development of AF. However, even despite the limited sample, the EAT depot was found to be more significant than the VAT depot and BMI in predicting the AF risk.The data that EAT depot and LA volume have the same effect on the arrhythmia risk indicates that patients with AF should be treated not only for hypertension, but also hidden obesity, which we can judge by EAT thickness.

PCSK9 plasma concentration is associated with epicardial adipose tissue volume and metabolic control in patients with type 1 diabetes

Patients with type 1 diabetes (T1D) have a greater risk of cardiovascular disease. Proconvertase subtilisin-kexin 9 (PCSK9) is involved in the atherosclerosis process. This study aimed to determine the relationship between PCSK9 levels and epicardial adipose tissue (EAT) volume and cardiometabolic variables in patients with T1D. This was an observational cross-sectional study including 73 patients with T1D. Clinical, biochemical and imaging data were collected. We divided the patients into two groups according to their glycemic control and the EAT index (iEAT) percentile. We performed a correlation analysis between the collected variables and PCSK9 levels; subsequently, we performed a multiple regression analysis with the significant parameters. The mean age was 47.6 ± 8.5 years, 58.9% were men, and the BMI was 26.9 ± 4.6 kg/m2. A total of 31.5%, 49.3% and 34.2% of patients had hypertension, dyslipidemia and smoking habit, respectively. The PCSK9 concentration was 0.37 ± 0.12 mg/L, which was greater in patients with worse glycemic control (HbA1c > 7.5%), dyslipidemia and high EAT volume (iEAT > 75th percentile). The PCSK9 concentration was positively correlated with age (r = 0.259; p = 0.027), HbA1c (r = 0.300; p = 0.011), insulin dose (r = 0.275; p = 0.020), VLDL-C level (r = 0.331; p = 0.004), TG level (r = 0.328; p = 0.005), and iEAT (r = 0.438; p < 0.001). Multiple regression analysis revealed that 25% of the PCSK9 variability was explained by iEAT and HbA1c (p < 0.05). The PCSK9 concentration is associated with metabolic syndrome parameters, poor glycemic control and increased EAT volume in patients with T1D.

Epicardial adipose tissue density predicts the presence of atrial fibrillation and its recurrence after catheter ablation: three-dimensional reconstructed image analysis.

Epicardial adipose tissue (EAT) induces inflammation in the atria and is associated with atrial fibrillation (AF). Several studies have examined the relationship between EAT volume (EAT-V) and density (EAT-D) and the presence of AF after catheter ablation. However, conclusions have been inconsistent. This study included 43 consecutive patients who underwent catheter ablation for AF and 30 control patients. EAT-V and EAT-D around the entire heart, entire atrium, left atrium (LA), and right atrium (RA) were measured in detail using reconstructed three-dimensional (3D) EAT images from dual-source computed tomography (CT). None of the measurements of EAT-V differed significantly between patients with AF and controls or between patients with recurrent AF and those without. On the other hand, all measurements of EAT-D were higher in patients with AF than in controls (entire atrium, p < 0.001; RA, p < 0.001; LA, p = 0.002). All EAT-D measurements were associated with the presence of AF. Among patients with AF who underwent ablation, all EAT-D measurements were higher in patients with recurrent AF than in those without. The difference was significant for EATRA-D (p = 0.032). All atrial EAT-D values predicted recurrent AF (EATRA-D: hazard ratio [HR], 1.208; 95% confidence interval [95% CI], 1.053-1.387; p = 0.007; EATLA-D: HR, 1.108; 95% CI 1.001-1.225; p = 0.047; EATatrial-D: HR, 1.174; 95% CI 1.040-1.325; p = 0.010). The most sensitive cutoffs for predicting recurrent AF were highly accurate for EATRA-D (area under the curve [AUC], 0.76; p < 0.01) and EATatrial-D (AUC = 0.75, p < 0.05), while the cutoff for EATLA-D had low accuracy (AUC, 0.65; p = 0.209). For predicting the presence of AF and recurrent AF after catheter ablation, 3D analysis of atrial EAT-D, rather than EAT-V, is useful.

Deep learning analysis of epicardial adipose tissue to predict cardiovascular risk in heavy smokers

BackgroundHeavy smokers are at increased risk for cardiovascular disease and may benefit from individualized risk quantification using routine lung cancer screening chest computed tomography. We investigated the prognostic value of deep learning-based automated epicardial adipose tissue quantification and compared it to established cardiovascular risk factors and coronary artery calcium.MethodsWe investigated the prognostic value of automated epicardial adipose tissue quantification in heavy smokers enrolled in the National Lung Screening Trial and followed for 12.3 (11.9–12.8) years. The epicardial adipose tissue was segmented and quantified on non-ECG-synchronized, non-contrast low-dose chest computed tomography scans using a validated deep-learning algorithm. Multivariable survival regression analyses were then utilized to determine the associations of epicardial adipose tissue volume and density with all-cause and cardiovascular mortality (myocardial infarction and stroke).ResultsHere we show in 24,090 adult heavy smokers (59% men; 61 ± 5 years) that epicardial adipose tissue volume and density are independently associated with all-cause (adjusted hazard ratios: 1.10 and 1.38; P < 0.001) and cardiovascular mortality (adjusted hazard ratios: 1.14 and 1.78; P < 0.001) beyond demographics, clinical risk factors, body habitus, level of education, and coronary artery calcium score.ConclusionsOur findings suggest that automated assessment of epicardial adipose tissue from low-dose lung cancer screening images offers prognostic value in heavy smokers, with potential implications for cardiovascular risk stratification in this high-risk population.