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Tuttolomondo D, Niccoli G, Martini C, D’Ascenzo F, De Filippo O, Nicolini F, Formica F, Carino D, Gurgoglione FL, Denegri A, Magnani G, Vignali L, De Filippo M, Sverzellati N, Ticinesi A, Bergamaschi L, Pizzi C, Gherbesi E, Suma S, Gaibazzi N. Cardiovascular Disease from Pathophysiology to Risk Estimation: Is Inflammation Estimated through Perivascular Attenuation on Computed Tomography the Key? Life (Basel) 2024; 14:457. [PMID: 38672728 PMCID: PMC11051374 DOI: 10.3390/life14040457] [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: 02/10/2024] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Systemic inflammation stands as a well-established risk factor for ischemic cardiovascular disease, as well as a contributing factor in the development of cardiac arrhythmias, notably atrial fibrillation. Furthermore, scientific studies have brought to light the pivotal role of localized vascular inflammation in the initiation, progression, and destabilization of coronary atherosclerotic disease. (2) Methods: We comprehensively review recent, yet robust, scientific evidence elucidating the use of perivascular adipose tissue attenuation measurement on computed tomography applied to key anatomical sites. Specifically, the investigation extends to the internal carotid artery, aorta, left atrium, and coronary arteries. (3) Conclusions: The examination of perivascular adipose tissue attenuation emerges as a non-invasive and indirect means of estimating localized perivascular inflammation. This measure is quantified in Hounsfield units, indicative of the inflammatory response elicited by dense adipose tissue near the vessel or the atrium. Particularly noteworthy is its potential utility in assessing inflammatory processes within the coronary arteries, evaluating coronary microvascular dysfunction, appraising conditions within the aorta and carotid arteries, and discerning inflammatory states within the atria, especially in patients with atrial fibrillation. The widespread applicability of perivascular adipose tissue attenuation measurement underscores its significance as a diagnostic tool with considerable potential for enhancing our understanding and management of cardiovascular diseases.
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Affiliation(s)
- Domenico Tuttolomondo
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Giampaolo Niccoli
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Martini
- Department of Diagnostic, Parma University Hospital, 43126 Parma, Italy
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, 10126 Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, 10126 Turin, Italy
| | - Francesco Nicolini
- Department of Cardiac Surgery, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Francesco Formica
- Department of Cardiac Surgery, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Davide Carino
- Department of Cardiac Surgery, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | | | - Andrea Denegri
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Giulia Magnani
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Luigi Vignali
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Dipartimento di Medicina e Chirurgia, University-Hospital of Parma, 43126 Parma, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
| | - Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Elisa Gherbesi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20154 Milan, Italy
| | - Sergio Suma
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
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Nodera M, Ishida T, Hasegawa K, Kakehashi S, Mukai M, Aoyama D, Miyazaki S, Uzui H, Tada H. Epicardial adipose tissue density predicts the presence of atrial fibrillation and its recurrence after catheter ablation: three-dimensional reconstructed image analysis. Heart Vessels 2024:10.1007/s00380-024-02384-8. [PMID: 38494555 DOI: 10.1007/s00380-024-02384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
Epicardial adipose tissue (EAT) induces inflammation in the atria and is associated with atrial fibrillation (AF). Several studies have examined the relationship between EAT volume (EAT-V) and density (EAT-D) and the presence of AF after catheter ablation. However, conclusions have been inconsistent. This study included 43 consecutive patients who underwent catheter ablation for AF and 30 control patients. EAT-V and EAT-D around the entire heart, entire atrium, left atrium (LA), and right atrium (RA) were measured in detail using reconstructed three-dimensional (3D) EAT images from dual-source computed tomography (CT). None of the measurements of EAT-V differed significantly between patients with AF and controls or between patients with recurrent AF and those without. On the other hand, all measurements of EAT-D were higher in patients with AF than in controls (entire atrium, p < 0.001; RA, p < 0.001; LA, p = 0.002). All EAT-D measurements were associated with the presence of AF. Among patients with AF who underwent ablation, all EAT-D measurements were higher in patients with recurrent AF than in those without. The difference was significant for EATRA-D (p = 0.032). All atrial EAT-D values predicted recurrent AF (EATRA-D: hazard ratio [HR], 1.208; 95% confidence interval [95% CI], 1.053-1.387; p = 0.007; EATLA-D: HR, 1.108; 95% CI 1.001-1.225; p = 0.047; EATatrial-D: HR, 1.174; 95% CI 1.040-1.325; p = 0.010). The most sensitive cutoffs for predicting recurrent AF were highly accurate for EATRA-D (area under the curve [AUC], 0.76; p < 0.01) and EATatrial-D (AUC = 0.75, p < 0.05), while the cutoff for EATLA-D had low accuracy (AUC, 0.65; p = 0.209). For predicting the presence of AF and recurrent AF after catheter ablation, 3D analysis of atrial EAT-D, rather than EAT-V, is useful.
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Affiliation(s)
- Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan.
| | - Tomokazu Ishida
- Department of Radiology, University of Fukui Hospital, Fukui, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Shota Kakehashi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
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Wang Z, Wang Y, Chen J, Ren L, Guo H, Chen X, Dong J, Chen Y, Sun Y. Impact of pericoronary adipose tissue attenuation on recurrence after radiofrequency catheter ablation for atrial fibrillation. Clin Cardiol 2023; 46:1244-1252. [PMID: 37436796 PMCID: PMC10577529 DOI: 10.1002/clc.24081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/03/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Inflammation plays a vital role in the occurrence and progression of atrial fibrillation (AF). The association between pericoronary adipose tissue attenuation (PCATA) and AF recurrence following ablation has not been fully clarified. HYPOTHESIS We aimed to evaluate the association between PCATA and AF recurrence after radiofrequency catheter ablation (RFCA). METHODS Patients who underwent the first RFCA for AF and performed coronary computed tomography angiography before ablation between 2018 and 2021 were enrolled. The predictive values of PCATA for AF recurrence after ablation were investigated. The area under curve (AUC), relative integrated discrimination improvement (IDI), and categorical free net reclassification improvement (NRI) were used to assess the discrimination ability of different models for AF recurrence. RESULTS During 1-year follow-up, 34.1% patients experienced AF recurrence. The multivariable analysis model revealed that PCATA of the right coronary artery (RCA) was an independent risk factor for AF recurrence. Patients with a high level of RCA-PCATA had a high risk of recurrence, after adjusting for other risk factors by restricted cubic splines. The performance in predicting AF recurrence was significantly improved by adding the marker of RCA-PCATA to the clinical model (AUC: 0.724 vs. 0.686, p = .024), with a relative IDI of 0.043 (p = .006) and continuous NRI of 0.521 (p < .001). CONCLUSIONS PCATA of RCA was independently associated with AF recurrence after ablation. PCATA may be helpful for risk classification for AF ablation patients.
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Affiliation(s)
- Zhe Wang
- Department of Cardiology, China‐Japan Friendship HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yi‐Jia Wang
- Department of Cardiology, Beijing HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Jia‐Wei Chen
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Li‐Chen Ren
- Department of RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - He‐He Guo
- Department of RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xiao‐Jie Chen
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Jian‐Zeng Dong
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
- Department of CardiologyAnzhen Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Ying‐Wei Chen
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Yi‐Hong Sun
- Department of Cardiology, China‐Japan Friendship HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
- Department of CardiologyChina‐Japan Friendship HospitalBeijingChina
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4
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Li N, Li YJ, Guo XJ, Wu SH, Jiang WF, Zhang DL, Wang KW, Li L, Sun YM, Xu YJ, Yang YQ, Qiu XB. Discovery of TBX20 as a Novel Gene Underlying Atrial Fibrillation. BIOLOGY 2023; 12:1186. [PMID: 37759586 PMCID: PMC10525918 DOI: 10.3390/biology12091186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
Atrial fibrillation (AF), the most prevalent type of sustained cardiac dysrhythmia globally, confers strikingly enhanced risks for cognitive dysfunction, stroke, chronic cardiac failure, and sudden cardiovascular demise. Aggregating studies underscore the crucial roles of inherited determinants in the occurrence and perpetuation of AF. However, due to conspicuous genetic heterogeneity, the inherited defects accounting for AF remain largely indefinite. Here, via whole-genome genotyping with genetic markers and a linkage assay in a family suffering from AF, a new AF-causative locus was located at human chromosome 7p14.2-p14.3, a ~4.89 cM (~4.43-Mb) interval between the markers D7S526 and D7S2250. An exome-wide sequencing assay unveiled that, at the defined locus, the mutation in the TBX20 gene, NM_001077653.2: c.695A>G; p.(His232Arg), was solely co-segregated with AF in the family. Additionally, a Sanger sequencing assay of TBX20 in another family suffering from AF uncovered a novel mutation, NM_001077653.2: c.862G>C; p.(Asp288His). Neither of the two mutations were observed in 600 unrelated control individuals. Functional investigations demonstrated that the two mutations both significantly reduced the transactivation of the target gene KCNH2 (a well-established AF-causing gene) and the ability to bind the promoter of KCNH2, while they had no effect on the nuclear distribution of TBX20. Conclusively, these findings reveal a new AF-causative locus at human chromosome 7p14.2-p14.3 and strongly indicate TBX20 as a novel AF-predisposing gene, shedding light on the mechanism underlying AF and suggesting clinical significance for the allele-specific treatment of AF patients.
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Affiliation(s)
- Ning Li
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China;
| | - Yan-Jie Li
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (Y.-J.L.); (S.-H.W.); (W.-F.J.)
| | - Xiao-Juan Guo
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai 200240, China; (X.-J.G.); (Y.-J.X.)
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
| | - Shao-Hui Wu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (Y.-J.L.); (S.-H.W.); (W.-F.J.)
| | - Wei-Feng Jiang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (Y.-J.L.); (S.-H.W.); (W.-F.J.)
| | - Dao-Liang Zhang
- Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen 518057, China;
| | - Kun-Wei Wang
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China;
| | - Li Li
- Key Laboratory of Arrhythmias, Ministry of Education of China, Tongji University School of Medicine, Shanghai 200092, China;
| | - Yu-Min Sun
- Department of Cardiology, Shanghai Jing’an District Central Hospital, Fudan University, Shanghai 200040, China;
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai 200240, China; (X.-J.G.); (Y.-J.X.)
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai 200240, China; (X.-J.G.); (Y.-J.X.)
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People′s Hospital, Fudan University, Shanghai 200240, China
- Cardiovascular Research Laboratory, Shanghai Fifth People’s Hospital, Fudan University, Shanghai 200240, China
- Central Laboratory, Shanghai Fifth People’s Hospital, Fudan University, Shanghai 200240, China
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; (Y.-J.L.); (S.-H.W.); (W.-F.J.)
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5
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Bergamaschi L, Pavon AG, Angeli F, Tuttolomondo D, Belmonte M, Armillotta M, Sansonetti A, Foà A, Paolisso P, Baggiano A, Mushtaq S, De Zan G, Carriero S, Cramer MJ, Teske AJ, Broekhuizen L, van der Bilt I, Muscogiuri G, Sironi S, Leo LA, Gaibazzi N, Lovato L, Pontone G, Pizzi C, Guglielmo M. The Role of Non-Invasive Multimodality Imaging in Chronic Coronary Syndrome: Anatomical and Functional Pathways. Diagnostics (Basel) 2023; 13:2083. [PMID: 37370978 DOI: 10.3390/diagnostics13122083] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact. Currently, various guidelines and recommendations have been published about chronic coronary syndromes (CCS). According to the recent European Society of Cardiology guidelines on chronic coronary syndrome, a multimodal imaging approach is strongly recommended in the evaluation of patients with suspected CAD. Today, in the current practice, non-invasive imaging methods can assess coronary anatomy through coronary computed tomography angiography (CCTA) and/or inducible myocardial ischemia through functional stress testing (stress echocardiography, cardiac magnetic resonance imaging, single photon emission computed tomography-SPECT, or positron emission tomography-PET). However, recent trials (ISCHEMIA and REVIVED) have cast doubt on the previous conception of the management of patients with CCS, and nowadays it is essential to understand the limitations and strengths of each imaging method and, specifically, when to choose a functional approach focused on the ischemia versus a coronary anatomy-based one. Finally, the concept of a pathophysiology-driven treatment of these patients emerged as an important goal of multimodal imaging, integrating 'anatomical' and 'functional' information. The present review aims to provide an overview of non-invasive imaging modalities for the comprehensive management of CCS patients.
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Affiliation(s)
- Luca Bergamaschi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Domenico Tuttolomondo
- Department of Cardiology, Parma University Hospital, Viale Antonio Gramsci 14, 43126 Parma, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giulia De Zan
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maarten-Jan Cramer
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Lysette Broekhuizen
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Ivo van der Bilt
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, 2545 GM The Hague, The Netherlands
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Laura Anna Leo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Viale Antonio Gramsci 14, 43126 Parma, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Marco Guglielmo
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, 2545 GM The Hague, The Netherlands
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Tonet E, Boccadoro A, Micillo M, Cocco M, Cossu A, Pompei G, Giganti M, Campo G. Coronary Computed Tomography Angiography: Beyond Obstructive Coronary Artery Disease. Life (Basel) 2023; 13:1086. [PMID: 37240730 PMCID: PMC10223586 DOI: 10.3390/life13051086] [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: 03/09/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Nowadays, coronary computed tomography angiography (CCTA) has a role of paramount importance in the diagnostic algorithm of ischemic heart disease (IHD), both in stable coronary artery disease (CAD) and acute chest pain. Alongside the quantification of obstructive coronary artery disease, the recent technologic developments in CCTA provide additional relevant information that can be considered as "novel markers" for risk stratification in different settings, including ischemic heart disease, atrial fibrillation, and myocardial inflammation. These markers include: (i) epicardial adipose tissue (EAT), associated with plaque development and the occurrence of arrhythmias; (ii) late iodine enhancement (LIE), which allows the identification of myocardial fibrosis; and (iii) plaque characterization, which provides data about plaque vulnerability. In the precision medicine era, these emerging markers should be integrated into CCTA evaluation to allow for the bespoke interventional and pharmacological management of each patient.
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Affiliation(s)
- Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Alberto Boccadoro
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Marco Micillo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Marta Cocco
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Alberto Cossu
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, 44121 Ferrara, Italy
| | - Graziella Pompei
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, 44121 Ferrara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
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7
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Ilyushenkova J, Sazonova S, Popov E, Batalov R, Minin S, Romanov A. Radiomic Phenotype of Periatrial Adipose Tissue in the Prognosis of Late Postablation Recurrence of Idiopathic Atrial Fibrillation. Sovrem Tekhnologii Med 2023; 15:48-58. [PMID: 37389017 PMCID: PMC10306967 DOI: 10.17691/stm2023.15.2.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Indexed: 07/01/2023] Open
Abstract
The aim of the study is to find new predictors of postablation atrial fibrillation (AF) recurrence in patients with lone AF using a texture analysis of the periatrial adipose tissue (PAAT) of the left atrium. Materials and Methods Forty-three patients admitted for lone AF catheter ablation, who had undergone multispiral coronary angiography, were enrolled in the study. PAAT segmentation was performed using 3D Slicer application followed by extraction of 93 radiomic features. At the end of the follow-up period, patients were divided into 2 groups depending on the presence or absence of AF recurrence. Results 12 months of follow-up after catheter ablation, postablation AF recurrence was reported in 19 out of 43 patients. Of 93 extracted radiomic features of PAAT, statistically significant differences were observed for 3 features of the Gray Level Size Zone matrix. At the same time, only one radiomic feature of PAAT, Size Zone Non Uniformity Normalized, was an independent predictor of postablative recurrence of AF after catheter ablation and 12 months of follow-up (McFadden's R2=0.451, OR - 0.506, 95% CI: 0.331‒0.776, p<0.001). Conclusion The radiomic analysis of periatrial adipose tissue may be considered as a promising non-invasive method for predicting adverse outcomes of the catheter treatment, which opens the possibilities for planning and correction of patient management tactics after intervention.
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Affiliation(s)
- J.N. Ilyushenkova
- Senior Researcher, Nuclear Medicine Department; Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 111a Kievskaya St., Tomsk, 634012, Russia
| | - S.I. Sazonova
- Head of Nuclear Medicine Department; Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 111a Kievskaya St., Tomsk, 634012, Russia
| | - E.V. Popov
- PhD Student, Nuclear Medicine Department; Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 111a Kievskaya St., Tomsk, 634012, Russia
| | - R.E. Batalov
- Leading Researcher, Department of Surgical Treatment of Advanced Heart Rhythm Disorders and Pacing; Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, 111a Kievskaya St., Tomsk, 634012, Russia
| | - S.M. Minin
- Head of the Nuclear Diagnosis Unit, Department of Radiological and Functional Diagnosis; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., 630055, Novosibirsk, Russia
| | - A.B. Romanov
- Deputy Director for Science; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., 630055, Novosibirsk, Russia
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Walpot J, Van Herck P, Van de Heyning CM, Bosmans J, Massalha S, Malbrain ML, Heidbuchel H, Inácio JR. Computed tomography measured epicardial adipose tissue and psoas muscle attenuation: new biomarkers to predict major adverse cardiac events (MACE) and mortality in patients with heart disease and critically ill patients. Part I: Epicardial adipose tissue. Anaesthesiol Intensive Ther 2023; 55:141-157. [PMID: 37728441 PMCID: PMC10496106 DOI: 10.5114/ait.2023.130922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/28/2023] [Indexed: 09/21/2023] Open
Abstract
Over the last two decades, the potential role of epicardial adipocyte tissue (EAT) as a marker for major adverse cardiovascular events has been extensively studied. Unlike other visceral adipocyte tissues (VAT), EAT is not separated from the adjacent myocardium by a fascial layer and shares the same microcirculation with the myocardium. Adipocytokines, secreted by EAT, interact directly with the myocardium through paracrine and vasocrine pathways. The role of the Randle cycle, linking VAT accumulation to insulin resistance, and the relevance of blood flow and mitochondrial function of VAT, are briefly discussed. The three available imaging modalities for the assessment of EAT are discussed. The advantages of echocardiography, cardiac CT, and cardiac magnetic resonance (CMR) are compared. The last section summarises the current stage of knowledge on EAT as a clinical marker for major adverse cardiovascular events (MACE). The association between EAT volume and coronary artery disease (CAD) has robustly been validated. There is growing evidence that EAT volume is associated with computed tomography coronary angiography (CTCA) assessed high-risk plaque features. The EAT CT attenuation coefficient predicts coronary events. Many studies have established EAT volume as a predictor of atrial fibrillation after cardiac surgery. Moreover, EAT thickness has been independently associated with severe aortic stenosis and mitral annular calcification. Studies have demonstrated that EAT volume is associated with heart failure. Finally, we discuss the potential role of EAT in critically ill patients admitted to the intensive care unit. In conclusion, EAT seems to be a promising new biomarker to predict MACE.
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Affiliation(s)
| | - Paul Van Herck
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Caroline M. Van de Heyning
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Manu L.N.G. Malbrain
- International Fluid Academy, Lovenjoel, Belgium
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - João R. Inácio
- Centro Universitario Hospitalar Lisboa Norte, Faculdade de Medicina de Lisboa, UL, Portugal
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Braillon A, Bernard A, Leclercq T, Duloquin G, Pommier T, Benali K, Comby PO, Loffroy R, Midulla M, Ricolfi F, Béjot Y, Guenancia C. Incremental value of the combined brain-cardiac CT protocol on prediction of atrial fibrillation after stroke. Eur Stroke J 2022; 8:175-182. [PMID: 37021162 PMCID: PMC10069180 DOI: 10.1177/23969873221138197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/21/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Atrial fibrillation (AF) is one of the most common causes of ischemic stroke. It is essential to target patients at highest risk of AF detected after stroke (AFDAS), who should benefit from a prolonged rhythm screening strategy. Cardiac-CT angiography (CCTA) was added to the stroke protocol used in our institution in 2018. We sought to assess, for AFDAS, the predictive value of atrial cardiopathy markers by a CCTA performed on admission for acute ischemic stroke. Patients and Methods: From November 2018 to October 2019, consecutive stroke patients with no history of AF were included. Let atrial volume (LAV), epicardial adipose tissue (EAT) attenuation and volume, and LAA characteristics were measured on CCTA. The primary endpoint was the presence of AFDAS at follow-up, diagnosed by continuous electrocardiographic monitoring, long-term external Holter monitoring during hospital stay, or implantable cardiac monitor (ICM). Results: Sixty of the 247 included patients developed AFDAS. Multivariable analysis shows independent predictors of AFDAS: age >80 years (HR 2.46; 95%CI (1.23–4.92), p = 0.011), indexed LAV >45 mL/m2 (HR 2.58; 95%CI (1.19–5.62), p = 0.017), EAT attenuation > −85HU (HR 2.16; 95%CI (1.13–4.15), p = 0.021) and LAA thrombus (HR 2.50; 95%CI (1.06–5.93), p = 0.037). Added consecutively to AFDAS prediction AS5F score (combining age and NIHSS >5), these markers had an incrementally better predictive value compared with the global Chi2 of the initial model ( p = 0.001, 0.035, and 0.015 respectively). Discussion and conclusion: Adding CCTA to the acute stroke protocol to assess markers of atrial cardiopathy associated with AFDAS may help to better stratify the AF screening strategy, including the use of an ICM.
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Affiliation(s)
| | | | | | | | - Thibaut Pommier
- Cardiology Department, University Hospital, Dijon, France
- PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France
| | - Karim Benali
- Cardiology Department, University Hospital, Dijon, France
| | | | | | - Marco Midulla
- Radiology Department, University Hospital, Dijon, France
| | | | - Yannick Béjot
- Neurology Department, University Hospital, Dijon, France
- PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France
| | - Charles Guenancia
- Cardiology Department, University Hospital, Dijon, France
- PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France
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Poggi AL, Gaborit B, Schindler TH, Liberale L, Montecucco F, Carbone F. Epicardial fat and atrial fibrillation: the perils of atrial failure. Europace 2022; 24:1201-1212. [PMID: 35274140 DOI: 10.1093/europace/euac015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/27/2022] [Indexed: 12/18/2022] Open
Abstract
Obesity is a heterogeneous condition, characterized by different phenotypes and for which the classical assessment with body mass index may underestimate the real impact on cardiovascular (CV) disease burden. An epidemiological link between obesity and atrial fibrillation (AF) has been clearly demonstrated and becomes even more tight when ectopic (i.e. epicardial) fat deposition is considered. Due to anatomical and functional features, a tight paracrine cross-talk exists between epicardial adipose tissue (EAT) and myocardium, including the left atrium (LA). Alongside-and even without-mechanical atrial stretch, the dysfunctional EAT may determine a pro-inflammatory environment in the surrounding myocardial tissue. This evidence has provided a new intriguing pathophysiological link with AF, which in turn is no longer considered a single entity but rather the final stage of atrial remodelling. This maladaptive process would indeed include structural, electric, and autonomic derangement that ultimately leads to overt disease. Here, we update how dysfunctional EAT would orchestrate LA remodelling. Maladaptive changes sustained by dysfunctional EAT are driven by a pro-inflammatory and pro-fibrotic secretome that alters the sinoatrial microenvironment. Structural (e.g. fibro-fatty infiltration) and cellular (e.g. mitochondrial uncoupling, sarcoplasmic reticulum fragmentation, and cellular protein quantity/localization) changes then determine an electrophysiological remodelling that also involves the autonomic nervous system. Finally, we summarize how EAT dysfunction may fit with the standard guidelines for AF. Lastly, we focus on the potential benefit of weight loss and different classes of CV drugs on EAT dysfunction, LA remodelling, and ultimately AF onset and recurrence.
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Affiliation(s)
- Andrea Lorenzo Poggi
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Bénédicte Gaborit
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN Marseille, France
| | - Thomas Hellmut Schindler
- Department of Radiology, Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Luca Liberale
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy
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