title: Association of Increased Epicardial Adipose Tissue Thickness With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation.
abstract: The thickness of epicardial adipose tissue (EAT) was reported to be highly associated with the incidence and severity of atrial fibrillation (AF). This study was conducted to analyze the ability of EAT thickness in predicting adverse cardiovascular (CV) events in AF. In 190 persistent AF patients, we performed a comprehensive transthoracic echocardiographic examination with assessment of EAT thickness. The definition of CV events included CV mortality, hospitalization for heart failure, myocardial infarction, and stroke. There were 69 CV events including 19 CV deaths, 32 hospitalizations for heart failure, 3 myocardial infarctions, and 15 strokes during a mean follow-up of 29 (25th-75th percentile: 17-36) months. The multivariable analysis demonstrates that chronic heart failure, increased left ventricular (LV) mass index and the ratio of transmitral E-wave velocity to early diastolic mitral annulus velocity, decreased body mass index, and increased EAT thickness (per 1-mm increase, odds ratio 1.224, 95% confidence interval [CI] 1.096-1.368, P < 0.001) were associated with adverse CV events. Additionally, the addition of EAT thickness to a model containing CHA2DS2-VASc score, left atrial volume index, and LV systolic and diastolic function significantly improved the values in predicting CV events (global χ increase 14.65, P < 0.001 and integrated discrimination improvement 0.10, 95% CI 0.04-0.16, P < 0.001). In AF, EAT thickness was useful in predicting adverse CV events. Additionally, EAT thickness could provide incremental value for CV outcome prediction over traditional clinical and echocardiographic parameters in AF.
authors.affiliation: From the Faculty of Medicine, College of Medicine (C-YC, W-HL, P-CH, T-HL, C-SL, H-WY, W-CV, W-TL, S-HS, H-MS); Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital (C-YC, W-HL, P-CH, M-KL, H-HL, C-AC, T-HL, C-SL, H-WY, W-CV, W-TL, S-HS, H-MS); and Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University (W-HL, M-KL, H-MS), Kaohsiung, Taiwan.
authors.forename: Chun-Yuan
authors.initials: CY
authors.lastname: Chu
authors.forename: Wen-Hsien
authors.initials: WH
authors.lastname: Lee
authors.forename: Po-Chao
authors.initials: PC
authors.lastname: Hsu
authors.forename: Meng-Kuang
authors.initials: MK
authors.lastname: Lee
authors.forename: Hung-Hao
authors.initials: HH
authors.lastname: Lee
authors.forename: Cheng-An
authors.initials: CA
authors.lastname: Chiu
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Lin
authors.forename: Chee-Siong
authors.initials: CS
authors.lastname: Lee
authors.forename: Hsueh-Wei
authors.initials: HW
authors.lastname: Yen
authors.forename: Wen-Chol
authors.initials: WC
authors.lastname: Voon
authors.forename: Wen-Ter
authors.initials: WT
authors.lastname: Lai
authors.forename: Sheng-Hsiung
authors.initials: SH
authors.lastname: Sheu
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality; D004452:Echocardiography / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology