van der Heijden Claudia A J, Verheule Sander, Olsthoorn Jules R, Mihl Casper, Poulina Lexan, van Kuijk Sander M J, Heuts Samuel, Maessen Jos G, Bidar Elham, Maesen Bart
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
Department of Physiology, Maastricht University, Maastricht, the Netherlands.
Int J Cardiol Heart Vasc. 2022 Feb 21;39:100976. doi: 10.1016/j.ijcha.2022.100976. eCollection 2022 Apr.
Atrial Epicardial Adipose Tissue (EAT) is presumably involved in the pathogenesis of atrial fibrillation (AF). The transient nature of postoperative AF (POAF) suggests that surgery-induced triggers provoke an unmasking of a pre-existent AF substrate. The aim is to investigate the association between the volume of EAT and the occurrence of POAF. We hypothesise that the likelihood of developing POAF is higher in patients with high compared to low left atrial (LA) EAT volumes.
Quantification of LA EAT based on the Hounsfield Units using custom made software was performed on pre-operative coronary computed tomography angiography scans of patients who underwent cardiac surgery between 2009 and 2019. Patients with mitral valve disease were excluded.
A total of 83 patients were included in this study (CABG = 34, aortic valve = 33, aorta ascendens n = 7, combination n = 9), of which 43 patients developed POAF. The EAT percentage in the LA wall nor indexed EAT volumes differed between patients with POAF and with sinus rhythm (all P > 0.05). In multivariable analysis, age and LA volume index (LAVI) were the only independent predictors for early POAF (OR: 1.076 and 1.056, respectively).
As expected, advanced age and LAVI were independent predictors of POAF. However, the amount of local EAT was not associated with the occurrence of AF after cardiac surgery. This suggests that the role of EAT in POAF is rather limited, or that the association of EAT in the early phase of POAF is obscured by the dominance of surgical-induced triggers.
心房心外膜脂肪组织（EAT）可能参与心房颤动（AF）的发病机制。术后房颤（POAF）的短暂性表明手术诱发因素会使先前存在的房颤基质暴露。目的是研究EAT体积与POAF发生之间的关联。我们假设，与左心房（LA）EAT体积低的患者相比，高EAT体积患者发生POAF的可能性更高。
使用定制软件，基于Hounsfield单位对2009年至2019年间接受心脏手术患者的术前冠状动脉计算机断层扫描血管造影进行LA EAT定量分析。排除二尖瓣疾病患者。
本研究共纳入83例患者（冠状动脉搭桥术=34例，主动脉瓣手术=33例，升主动脉手术=7例，联合手术=9例），其中43例发生POAF。POAF患者和窦性心律患者的LA壁EAT百分比及EAT体积指数均无差异（所有P>0.05）。多变量分析中，年龄和LA体积指数（LAVI）是早期POAF的唯一独立预测因素（OR分别为1.076和1.056）。
正如预期的那样，高龄和LAVI是POAF的独立预测因素。然而，局部EAT的量与心脏手术后房颤的发生无关。这表明EAT在POAF中的作用相当有限，或者在POAF早期阶段EAT的关联被手术诱发因素的主导作用所掩盖。
