van Rosendael Alexander R, Smit Jeff M, El'Mahdiui Mohammed, van Rosendael Philippe J, Leung Melissa, Delgado Victoria, Bax Jeroen J
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
Europace. 2022 Sep 1;24(8):1223-1228. doi: 10.1093/europace/euac031.
Left atrial (LA) volume and LA epicardial fat are both substrates for atrial fibrillation (AF), but may relate with AF at different (early vs. late) stages in the AF disease process. We evaluated associations between LA epicardial fat and LA volume in patients with sinus rhythm (SR), paroxysmal AF (PAF), and persistent/permanent AF.
In total, 300 patients (100 with SR, 100 with PAF, and 100 with persistent/permanent AF) who underwent cardiac computed tomography angiography (CTA) were included. The epicardial fat mass posterior to the LA and the LA volume were quantified from CTA and compared between patients with SR, PAF, and persistent/permanent AF. Furthermore, four groups were created by classifying LA epicardial fat and LA volume into large or small according to their median. The mean age of the population was 58.9 ± 10.5 years and 69.7% was male. Left atrial epicardial fat mass was larger in patients with PAF compared with SR, but did not further increase from PAF to persistent/permanent AF. Left atrial volume increased significantly from SR to PAF and to persistent/permanent AF. Left atrial epicardial fat and LA volume were both concordantly large or small in 184 (61%) patients, and discordant in 116 (39%). When both were small, 65.2% of the patients had SR, 23.9% PAF, and 10.9% persistent/permanent AF. When the LA epicardial fat mass was large and the LA volume small (compared with both being small), patients were significantly more often in PAF (55.2 vs. 23.9, P < 0.05), less frequently in SR (32.8% vs. 65.2%, P < 0.05) but showed comparable rates of persistent/permanent AF (12.0% vs. 10.9%, P < 0.05). When the LA volume was large, most patients had persistent/permanent AF.
Left atrial epicardial fat mass was larger in PAF vs. SR, possibly indicating a marker of early disease, while large LA volumes were associated with a high prevalence of persistent/permanent AF. Elevated LA epicardial fat mass without large LA volume may reflect the early AF disease process.
左心房（LA）容积和左心房心外膜脂肪均为心房颤动（AF）的基质，但在AF疾病进程的不同阶段（早期与晚期）可能与AF存在不同关联。我们评估了窦性心律（SR）、阵发性AF（PAF）和持续性/永久性AF患者的左心房心外膜脂肪与左心房容积之间的关联。
总共纳入了300例行心脏计算机断层扫描血管造影（CTA）的患者（100例SR患者、100例PAF患者和100例持续性/永久性AF患者）。从CTA中对左心房后方的心外膜脂肪量和左心房容积进行量化，并在SR、PAF和持续性/永久性AF患者之间进行比较。此外，根据中位数将左心房心外膜脂肪和左心房容积分为大或小，从而形成四组。研究人群的平均年龄为58.9±10.5岁，男性占69.7%。与SR患者相比，PAF患者的左心房心外膜脂肪量更大，但从PAF到持续性/永久性AF并未进一步增加。左心房容积从SR到PAF再到持续性/永久性AF显著增加。184例（61%）患者的左心房心外膜脂肪和左心房容积均为一致的大或小，116例（39%）则不一致。当两者均小时，65.2%的患者为SR，23.9%为PAF，10.9%为持续性/永久性AF。当左心房心外膜脂肪量大而左心房容积小（与两者均小相比）时，患者PAF的发生率显著更高（55.2对23.9，P<0.05），SR的发生率更低（32.8%对65.2%，P<0.05），但持续性/永久性AF的发生率相当（12.0%对10.9%，P<0.05）。当左心房容积大时，大多数患者为持续性/永久性AF。
与SR相比，PAF患者的左心房心外膜脂肪量更大，这可能表明是疾病早期的一个标志物，而左心房容积大与持续性/永久性AF的高患病率相关。左心房心外膜脂肪量升高而左心房容积不大可能反映AF疾病的早期进程。
