Association of epicardial adipose tissue and left atrial size on non-contrast CT with atrial fibrillation: the Heinz Nixdorf Recall Study.
OBJECTIVE
Epicardial adipose tissue (EAT) is increased in subjects with atrial fibrillation (AF). Likewise, EAT is associated with left atrial (LA) size, as itself is a strong predictor of AF. We aimed to determine the association of EAT and LA size as computed tomography (CT)-derived measures with prevalent and incident AF and investigated whether both measures independently predict AF.


RESULTS
Participants from the Heinz Nixdorf Recall study without known cardiovascular disease were included. At baseline, EAT, defined as fat volume inside the pericardial sac, and LA size, defined as an axial area at the level of the mitral valve, were quantified from non-contrast enhanced cardiac CT. AF was determined from electrocardiogram at baseline and also at 5-year follow-up examination. Overall, 3467 participants (age: 58.9 ± 7.6 years, 47% male) were included. Ninety-six subjects had AF (46 prevalent and 50 incident). A 1-standard deviation (SD) change of EAT was associated with nearly two-fold increased prevalence of AF in univariate analysis, which persisted after adjustment for AF risk factors [odds ratio (OR) (95% confidence interval, 95% CI): 1.38 (1.11-1.72), P = 0.003]. Ancillary adjusting for LA reduced the effect [1.26 (0.996-1.60), P = 0.054]. For incident AF, no relevant effect was observed for EAT when adjusting for risk factors [1.19 (0.88-1.61), P = 0.26]. In contrast, a 1-SD chance of LA was strongly associated with AF independently of EAT and risk factors [2.70 (2.22-2.20), P < 0.0001]. LA but not EAT as non-contrast CT-derived measures improved the prediction of AF over risk factors (receiver operating characteristics: 0.810-0.845, P = 0.025).


CONCLUSIONS
LA size from non-contrast CT is strongly associated with prevalent and incident AF and ultimately diminishes the link of EAT with AF.
Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany amir-abbas.mahabadi@uk-essen.de.
Amir A
AA
Mahabadi
Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Nils
N
Lehmann
Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Hagen
H
Kälsch
Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Marcus
M
Bauer
Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Iryna
I
Dykun
Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Kaffer
K
Kara
Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Susanne
S
Moebus
Institute of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Karl-Heinz
KH
Jöckel
Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Raimund
R
Erbel
Department of Cardiology, Krankenhaus Bethanien, Moers, Germany.
Stefan
S
Möhlenkamp
D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000473:pathology; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000473:pathology; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
Atrial fibrillation; Cardiac computed tomography; Epicardial adipose tissue; Heinz Nixdorf Recall Study; Left atrium