Yorgun Hikmet, Canpolat Uğur, Aytemir Kudret, Hazırolan Tuncay, Şahiner Levent, Kaya Ergün Barış, Kabakci Giray, Tokgözoğlu Lale, Özer Necla, Oto Ali
Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Int J Cardiovasc Imaging. 2015 Mar;31(3):649-57. doi: 10.1007/s10554-014-0579-5. Epub 2014 Dec 3.
Epicardial adipose tissue (EAT), as an endocrine organ, may serve as a source of pro-inflammatory cytokines. Also, given the strong relationship between atrial fibrillation (AF), obesity and inflammation, the purpose of this study was to investigate the association of non-valvular AF with epicardial and periatrial fat. A total of 618 (192 in sinus rhythm, 169 with paroxysmal AF, 133 with persistent AF and 124 with permanent AF) patients who underwent CT angiography for the evaluation of CAD or pulmonary vein anatomy before catheter ablation were enrolled in this study. Thickness of the EAT and periatrial fat were measured by CT angiography. Together with body mass index, these were examined in relation to the presence and severity of AF and left atrial (LA) diameter. Patients with AF had significantly more total EAT and periatrial fat thickness compared with patients in sinus rhythm (p < 0.001). EAT thickness was significantly higher in permanent, persistent and paroxysmal AF compared with sinus rhythm group (p < 0.001). Multivariable multinomial logistic regression analysis comparing patients with sinus rhythm and subtypes of AF revealed a significant association between periatrial fat and total EAT thickness with all AF subtypes. Correlation analysis demonstrated that both total EAT thickness and periatrial fat thickness were significantly correlated with LA diameter (p < 0.05). Epicardial fat thickness is associated with both the presence and severity of AF independent of all other risk factors including LA diameter. Mediators for the association of EAT with AF pathophysiology requires future large scale prospective studies.
心外膜脂肪组织（EAT）作为一个内分泌器官，可能是促炎细胞因子的来源。此外，鉴于心房颤动（AF）、肥胖与炎症之间的密切关系，本研究旨在探讨非瓣膜性AF与心外膜脂肪和心房周围脂肪的关联。本研究纳入了618例患者（192例处于窦性心律，169例阵发性AF，133例持续性AF，124例永久性AF），这些患者在进行导管消融术前接受了CT血管造影以评估CAD或肺静脉解剖结构。通过CT血管造影测量EAT和心房周围脂肪的厚度。连同体重指数一起，对这些指标与AF的存在和严重程度以及左心房（LA）直径进行了检查。与窦性心律患者相比，AF患者的EAT总量和心房周围脂肪厚度明显更多（p < 0.001）。与窦性心律组相比，永久性、持续性和阵发性AF患者的EAT厚度明显更高（p < 0.001）。比较窦性心律患者与AF各亚型患者的多变量多项逻辑回归分析显示，心房周围脂肪和EAT总厚度与所有AF亚型之间存在显著关联。相关性分析表明，EAT总厚度和心房周围脂肪厚度均与LA直径显著相关（p < 0.05）。心外膜脂肪厚度与AF的存在和严重程度相关，独立于包括LA直径在内的所有其他危险因素。EAT与AF病理生理学关联的介质需要未来大规模前瞻性研究。
