Excessive interatrial adiposity is associated with left atrial remodeling, augmented contractile performance in asymptomatic population

Relationship of Pericardial Fat Tissue With Cardiovascular Risk Factors in Patients Without Cardiovascular Diseases

Background: Obesity and related cardiovascular diseases (CVDs) are important public health problems. The role of visceral ectopic fat remains contested. We studied the relationship between pericardial fat tissue (PFT) volume and CVD risk factors. Methods: We examined 320 patients (average age 63.8 ± 19.9 years) without manifested CVD. Anthropometric indicators were measured, and body mass index (BMI) was calculated. The total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides were assessed. Cardiovascular (CV) risk was calculated using the SCORE system. All patients underwent chest computed tomography with detection of PFT volume using specialized semiautomatic software. Results: Among study participants with normal body mass, the PFT volume was 1.95 cm³ [2.1; 3.9], while it was 3.0 cm³ [2.0; 3.7] in overweight patients and 3.6 cm³ [2.7; 4.7] in obese patients (P < 0.001). Patients with hypertension (HTN) also had significantly higher PFT volumes compared with individuals without HTN: 3.1 cm³ [2.3; 4.15] versus 1.8 cm³ [1.0; 2.5] (P < 0.001). Patients with higher CV risk had significantly higher PFT volume, categorized as follows: 1.6 cm³ [1.0; 2.4], low risk; 2.24 cm³ [2.0; 3.1], moderate risk; 3.1 cm³ [2.4; 3.7], high risk; and 3.9 cm³ [3.0; 5.1], very high risk, respectively (P < 0.001). Results of multiple regression demonstrated that waist circumference and HDL-C were significantly associated with PFT volume. Another model revealed a significant association of BMI and PFT volume with the level of CV risk. Conclusions: This study demonstrates the association of PFT volume with the major diagnostic criteria of obesity, HTN, lipid disorders, and CV risk measured by the SCORE system.

Associations of region-specific visceral adiposity with subclinical atrial dysfunction and outcomes of heart failure

AIMS

Excessive visceral adiposity (VAT) plays an essential role in metabolic derangements with those close to heart further mediates myocardial homeostasis. The disparate biological links between region-specific VAT and cardiometabolic profiles as mediators influencing atrial kinetics remain unexplored.

METHODS AND RESULTS

Among 1326 asymptomatic individuals, region-specific VAT including peri-aortic root fat (PARF) and total pericardial fat (PCF) of cardiac region, together with thoracic peri-aortic adipose tissue (TAT), was assessed using multiple-detector computed tomography. VAT measures were related to functional left atrial (LA) metrics assessed by speckle-tracking algorithm and clinical outcomes of atrial fibrillation (AF) and heart failure (HF). Multivariate linear regression models incorporating body fat, metabolic syndrome, and E/TDI-e' consistently demonstrated independent associations of larger PARF/PCF with peak atrial longitudinal systolic strain (PALS) reduction, higher LA stiffness, and worsened strain rate components; instead, TAT was independently associated with cardiometabolic profiles. PARF rather than PCF or TAT conferred independent prognostic values for incident AF/HF by multivariate Cox regression (adjusted hazard ratio: 1.56, 95% confidence interval: 1.17-2.08, P = 0.002) during a median of 1790 days (interquartile range: 25th to 75th: 1440-1927 days) of follow-up, with subjects categorized into worst PALS and largest VAT tertiles demonstrating highest events (all log-rank P < 0.001). Mediation analysis showed that higher triglyceride and lower high-density lipoproteins may serve as intermediary factors for effects between VAT and LA functional metrics, with lesser role by glucose level.

CONCLUSIONS

Visceral adiposity surrounding atrial region was tightly associated with subclinical atrial dysfunction and incident AF or HF beyond metabolic factors. Instead, peri-aortic adiposity may mediate their toxic effects mainly through circulating cardiometabolic profiles.

Meta-Analysis of Relation of Epicardial Adipose Tissue Volume to Left Atrial Dilation and to Left Ventricular Hypertrophy and Functions

Many studies have explored the hypothesis that epicardial adipose tissue (EAT) accumulation adversely affects cardiac remodeling. We assessed, through a systematic review and meta-analysis, whether EAT is linked to left atrial (LA) and left ventricular (LV) structure and function, irrespective of global or abdominal visceral adiposity. We searched MEDLINE, Scopus, and Web of Science for studies evaluating the association of EAT volume quantified by computed tomography with cardiac morphology and function. We used DerSimonian and Laird random-effects models to summarize the adjusted-effect of 10 ml variation of EAT on LA size, LV mass, LV diastolic and systolic functions parameters, and presence of diastolic dysfunction. We quantified heterogeneity using I² statistic. We included 19 studies. Quantitative analysis by cardiac parameters, including LA dimension (n = 2,719), LV mass (n = 2,519), diastolic function (n = 3,741), and systolic function (n = 2,037) showed that EAT was associated with LA dilation (pooled B-coefficient: 0.12 mm; 95% confidence interval [CI] 0.08 to 0.17; I²: 97%), LV hypertrophy (pooled B-coefficient: 1.21 g; 95% CI 0.63 to 1.79; I²: 77%), diastolic dysfunction (odds ratio: 1.35; 95% CI 1.16 to 1.57; I²: 0%), higher E/E' ratio (pooled B-coefficient: 0.28 cm/s; 95% CI 0.08 to 0.49; I²: 67%), lower E' velocity (pooled B-coefficient: -0.16 cm/s; 95% CI -0.22 to -0.09; I²: 43%), and E/A ratio (pooled B-coefficient: -0.01; 95% CI -0.02 to -0.001; I²: 70%), independently of body mass index. There was no association between EAT and LV systolic function. In conclusion, EAT volume measured by computed tomography was independently associated with LA dilation, LV hypertrophy, and diastolic dysfunction.

Effect of epicardial fat and metabolic syndrome on reverse atrial remodeling after ablation for atrial fibrillation

BACKGROUND

Metabolic syndrome/epicardial adipose tissue (EAT) plays an important role in atrial fibrillation (AF). Although reverse atrial remodeling (RAR) often occurs after AF ablation, the effects of EAT on RAR remain unknown.

METHODS

Study subjects were 104 patients in whom transthoracic echocardiography (TTE) was performed before AF ablation and 3, 6, and 12 months afterward. EAT was assessed in terms of its thickness adjacent to the right ventricular anterior wall in the TTE parasternal view. RAR was defined as >10% reduction in the left atrial volume (LAV) index by the 3-month follow-up examination.

RESULTS

Postablation RAR occurred in 57/104 (55%) patients. RAR absence was associated with a relatively thick EAT (4.92 ± 1.65 vs. 3.92 ± 1.17 mm, P = 0.0005), small LAV index (24.6 ± 7.5 vs. 28.8 ± 10.6 mL/m2, P = 0.0233), and metabolic syndrome (62% vs. 28%, P = 0.0006). Metabolic syndrome and EAT were shown to be independent predictors of RAR absence. Thick EAT was significantly associated with AF recurrence after ablation (5.05 ± 2.19 mm vs. 4.17 ± 1.16 mm for no AF recurrence group, P = 0.0116), but metabolic syndrome was not (48% vs. 42%, P = 0.6189). Despite no change in body weight, EAT thickness decreased significantly by 12 months in patients without AF recurrence (4.17 ± 1.16 vs. 3.65 ± 1.16 mm, P < 0.0001).

CONCLUSIONS

EAT and metabolic syndrome appear to be strongly associated with RAR absence, but only the thick EAT was significantly associated with the postablation AF recurrence. Our findings, especially the thinning of EAT, suggest that thick EAT lead to AF vulnerability but that EAT reduction favorably affects ablation outcome.