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Huber AT, Fankhauser S, Wittmer S, Chollet L, Lam A, Maurhofer J, Madaffari A, Seiler J, Servatius H, Haeberlin A, Noti F, Brugger N, von Tengg-Kobligk H, Gräni C, Roten L, Tanner H, Reichlin T. Epicardial adipose tissue dispersion at CT and recurrent atrial fibrillation after pulmonary vein isolation. Eur Radiol 2024:10.1007/s00330-023-10498-2. [PMID: 38197916 DOI: 10.1007/s00330-023-10498-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Epicardial adipose tissue (EAT) remodeling is associated with atrial fibrillation (AF). Left atrial (LA) EAT dispersion on cardiac CT is a non-invasive imaging biomarker reflecting EAT heterogeneity. We aimed to investigate the association of LA EAT dispersion with AF recurrence after pulmonary vein isolation (PVI). METHODS In a prospective registry of consecutive patients undergoing first PVI, mean EAT attenuation values were measured on contrast-enhanced cardiac CT scans in Hounsfield units (HU) within low (- 195 to - 45 HU) and high (- 44 to - 15 HU) threshold EAT compartments around the left atrium (LA). EAT dispersion was defined as the difference between the mean HU values within the two EAT compartments. Continuous variables were compared between groups using the Mann-Whitney U test and cox proportional hazard models were used to calculate hazard ratios of predictors of 1-year AF recurrence. RESULTS A total of 208 patients were included, 135 with paroxysmal AF and 73 with persistent AF. LA EAT dispersion was significantly larger in patients with persistent compared to paroxysmal AF (52.6 HU vs. 49.9 HU; p = 0.001). After 1 year of follow-up, LA EAT dispersion above the mean (> 50.8 HU) was associated with a higher risk of AF recurrence (HR 2.3, 95% CI 1.5-3.6; p < 0.001). It retained its predictive value when corrected for age, sex, body mass index, LA volume, and AF type (HR 2.8, 95% CI 1.6-4.6; p < 0.001). CONCLUSION A larger LA EAT dispersion on contrast-enhanced cardiac CT scans, reflecting EAT heterogeneity, is independently associated with AF recurrence after PVI. CLINICAL RELEVANCE STATEMENT Based on LA EAT dispersion assessment, a more accurate risk stratification and patient selection may be possible based on a pre-procedural cardiac CT when planning PVI. KEY POINTS • Epicardial adipose tissue (EAT) remodeling is associated with atrial fibrillation (AF). • A larger left atrial EAT dispersion in a pre-procedural cardiac CT was associated with a higher 1-year AF recurrence risk after pulmonary vein isolation. • A pre-procedural cardiac CT with left atrial EAT dispersion assessment may provide a more accurate risk stratification and patient selection for PVI.
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Affiliation(s)
- Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland, Lucerne, Switzerland.
| | - Severin Fankhauser
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Severin Wittmer
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Laureve Chollet
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Anna Lam
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
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Huber AT, Fankhauser S, Chollet L, Wittmer S, Lam A, Baldinger S, Madaffari A, Seiler J, Servatius H, Haeberlin A, Noti F, Brugger N, von Tengg-Kobligk H, Gräni C, Roten L, Tanner H, Reichlin T. The Relationship between Enhancing Left Atrial Adipose Tissue at CT and Recurrent Atrial Fibrillation. Radiology 2022; 305:56-65. [PMID: 35670718 DOI: 10.1148/radiol.212644] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The association of epicardial adipose tissue (EAT) and its metabolic activity with atrial fibrillation (AF) is an area of active investigation. Left atrial (LA) enhancing EAT (e-EAT) at cardiac CT may be a noninvasive surrogate marker for the metabolic activity of EAT. Purpose To determine the relationship between LA e-EAT and recurrence after AF ablation. Materials and Methods In a secondary analysis of a prospective registry of consecutive patients (from July 2018 to December 2019) undergoing first AF ablation, total and LA EAT were segmented on preprocedural noncontrast- and contrast-enhanced cardiac CT scans. LA e-EAT volume fraction was defined as the LA EAT volume difference between the noncontrast- and contrast-enhanced scan divided by the total LA EAT volume on the noncontrast-enhanced scan (threshold values, -15 HU to -195 HU). Continuous variables were compared between groups by using the Mann-Whitney U test. Cox proportional hazard models were used to calculate hazard ratios of predictors of 1-year AF recurrence. Results A total of 212 patients (mean age, 64 years; 159 men) who underwent a first AF ablation were included (paroxysmal AF, 64%; persistent AF, 36%). The LA EAT volume was higher in patients with persistent versus paroxysmal AF (50 cm3 [IQR, 37-72] vs 37 [IQR, 27-49]; P < .001), but no difference was found for LA e-EAT (P = .09). After 1 year of follow-up, AF recurrence rate was 77 of 212 (36%). LA e-EAT above the mean (>33%) was associated with a higher risk of AF recurrence (hazard ratio [HR], 2.1; 95% CI: 1.3, 3.3; P < .01). In a multivariable Cox regression analysis, LA e-EAT retained its predictive value when corrected for sex, age, AF phenotype, LA volume index, and LA EAT volume (HR, 1.9; 95% CI: 1.1, 3.1; P = .02). Conclusion Left atrial enhancing epicardial adipose tissue was independently associated with recurrence after atrial fibrillation ablation. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Stojanovska in this issue.
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Affiliation(s)
- Adrian Thomas Huber
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Severin Fankhauser
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Laurève Chollet
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Severin Wittmer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Anna Lam
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Samuel Baldinger
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Antonio Madaffari
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Jens Seiler
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Helge Servatius
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Andreas Haeberlin
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Fabian Noti
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Nicolas Brugger
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Christoph Gräni
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Laurent Roten
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Hildegard Tanner
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Tobias Reichlin
- From the Department of Diagnostic, Interventional and Pediatric Radiology (A.T.H., S.F., H.v.T.K.) and Department of Cardiology (S.F., L.C., S.W., A.L., S.B., A.M., J.S., H.S., A.H., F.N., N.B., C.G., L.R., H.T., T.R.), Inselspital University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
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