Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Int J Cardiovasc Imaging. 2021 Apr;37(4):1383-1393. doi: 10.1007/s10554-020-02092-0. Epub 2021 Jan 3.
Atrial fibrillation (AF) is the most common arrhythmia and potentially increase the risk of embolic stroke and aggravate progressive heart failure in patients with hypertrophic cardiomyopathy (HCM). Recent studies demonstrated that epicardial adipose tissue (EAT) was closely associated with AF in general population. However, the relationship between EAT and AF in HCM patients remains unclear. A total of 93 consecutive patients with hypertrophic obstructive cardiomyopathy (HOCM) at Fuwai Hospital were enrolled in our study. There were 18 patients with AF and 75 patients without it. Cardiac magnetic resonance (CMR) imaging was performed in all participants. EAT volume (EATV) and left atrial volume (LAV) were determined by E-3D medical model software. HOCM patients with AF had significantly greater EATV index (EATVI, P < 0.001), LAV index (LAVI, P < 0.001) and left ventricular end-systole volume index (LVESVI, P = 0.039), and lower left ventricular ejection fraction (LVEF, P = 0.002). In multivariable logistic regression analysis, EATVI, LAVI, and LVEF remained independent determinants of AF occurrence (OR = 1.023, 95% CI, 1.003-1.043, P = 0.023, OR = 1.043, 95% CI, 1.012-1.075, P = 0.006, and OR = 0.887, 95% CI, 0.818-0.962, P = 0.004, respectively). Furthermore, receiver operating characteristic (ROC) curve analysis demonstrated that integration of EATVI, LAVI and LVEF provided better discriminatory performance for incident AF in HOCM patients with a high sensitivity of 94.4% and a specificity of 69.3% (AUC = 0.864, 95% CI, 0.771-0.958, P < 0.001). EATVI is an independent predictor of the presence of AF, and integration of EATVI, LVEF and LAVI determined by CMR provide greater discriminatory performance for identifying AF in HOCM patients.
心房颤动（AF）是最常见的心律失常，可能会增加肥厚型心肌病（HCM）患者发生栓塞性中风和加重进行性心力衰竭的风险。最近的研究表明，心外膜脂肪组织（EAT）与一般人群中的 AF 密切相关。然而，EAT 与 HCM 患者 AF 之间的关系尚不清楚。本研究纳入了阜外医院 93 例连续的肥厚型梗阻性心肌病（HOCM）患者，其中 18 例为 AF 患者，75 例为非 AF 患者。所有参与者均进行心脏磁共振（CMR）成像。通过 E-3D 医学模型软件确定心外膜脂肪组织体积（EATV）和左心房容积（LAV）。AF 组 HOCM 患者的 EATV 指数（EATVI，P<0.001）、左心房容积指数（LAVI，P<0.001）和左心室收缩末期容积指数（LVESVI，P=0.039）明显更高，左心室射血分数（LVEF，P=0.002）明显更低。多变量逻辑回归分析显示，EATVI、LAVI 和 LVEF 仍然是 AF 发生的独立决定因素（OR=1.023，95%CI，1.003-1.043，P=0.023；OR=1.043，95%CI，1.012-1.075，P=0.006；OR=0.887，95%CI，0.818-0.962，P=0.004）。此外，受试者工作特征（ROC）曲线分析表明，EATVI、LAVI 和 LVEF 的整合为 HOCM 患者的 AF 提供了更好的鉴别性能，具有 94.4%的高灵敏度和 69.3%的特异性（AUC=0.864，95%CI，0.771-0.958，P<0.001）。EATVI 是 AF 存在的独立预测因子，CMR 确定的 EATVI、LVEF 和 LAVI 的整合为识别 HOCM 患者的 AF 提供了更好的鉴别性能。
