title: The Abundance of Epicardial Adipose Tissue Surrounding Left Atrium Is Associated With the Occurrence of Stroke in Patients With Atrial Fibrillation.
abstract: Epicardial adipose tissue (EAT) is positively associated with risk factors for cardiovascular disease, but the role of EAT in the development of atrial fibrillation (AF)-related stroke and its association with the anatomical and functional remodeling of the left atrium (LA) have not been elucidated.This was a comparative cross-sectional study. Twenty-seven patients with paroxysmal or persistent AF and cardioembolic stroke were selected and compared with 68 age- and sex-matched AF patients without stroke. In addition, 20 controls without a history of AF or stroke were included. The periatrial EAT and the structural and functional properties of the LA and left ventricle were evaluated using contrast-enhanced 64-slice multidetector computed tomography during sinus rhythm. Total EAT around the LA was significantly increased across the groups (control vs AF vs AF-related stroke, P < 0.001). The volumes of the LA and the LA appendage (LAA) were also significantly increased across the 3 groups (P < 0.001 for each). The emptying fraction of the LA and LAA and the booster-pump function of the LA and LAA were all reduced across the 3 groups (P < 0.001 for all). In addition, the Hounsfield unit (HU) ratio of the LAA to the ascending aorta (LAA/AA) was also decreased in patients with stroke (P < 0.001). Furthermore, EAT had a negative correlation with the dynamic function of the LA, LAA, and the HU ratio. After a multivariate analysis, increased EAT (P < 0.001) was shown to be independently associated with the occurrence of AF-related stroke.Periatrial EAT was increased and was correlated with atrial dysfunction in patients with AF-related stroke. Hence, EAT assessment may potentially offer an incremental value for grading the risk of cardioembolic stroke in patients with AF.
authors.affiliation: From the Division of Cardiology, National Yang Ming University Hospital, Yi-Lan (H-MT) Department of Biomedical Engineering, Chung-Yuan Christian University, Taoyuan (W-CH); Division of Neurology, (P-HT, C-LL, F-CL); Department of Radiology, National Yang Ming University Hospital, Yi-Lan (H-HW); and Cardiovascular Research Center, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan (L-WL, S-LC, T-FC, S-AC).
authors.forename: Hsuan-Ming
authors.initials: HM
authors.lastname: Tsao
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Hu
authors.forename: Ping-Huang
authors.initials: PH
authors.lastname: Tsai
authors.forename: Chao-Lin
authors.initials: CL
authors.lastname: Lee
authors.forename: Fang-Chun
authors.initials: FC
authors.lastname: Liu
authors.forename: Hsueh-Han
authors.initials: HH
authors.lastname: Wang
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Lo
authors.forename: Shih-Lin
authors.initials: SL
authors.lastname: Chang
authors.forename: Tze-Fan
authors.initials: TF
authors.lastname: Chao
authors.forename: Shih-Ann
authors.initials: SA
authors.lastname: Chen
mesh_terms: D000273:Adipose Tissue; D001281:Atrial Fibrillation / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D020521:Stroke / Q000209:etiology*