What is the clinical evidence from this study?

Study design: Observational. Population: Idiopathic Hypertrophic Cardiomyopathy (n=62). Intervention: Epicardial Adipose Tissue (EAT) area vs. Lower EAT area. Primary outcome: Prevalent Atrial Fibrillation (OR 1.28, 95% CI 1.03-1.58, p=0.03).

January 1, 2013Open Access

Epicardial Adipose Tissue Is Associated With Prevalent Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Key Result

Increased epicardial adipose tissue area was significantly associated with prevalent atrial fibrillation in patients with hypertrophic cardiomyopathy (adjusted OR 1.28).

Study Design

Type

Observational (n=62)

Multicenter

Structured PICO

Is increased epicardial adipose tissue area associated with prevalent atrial fibrillation in patients with hypertrophic cardiomyopathy?

Population

62 Japanese patients with idiopathic hypertrophic cardiomyopathy evaluated retrospectively to determine the association between epicardial adipose tissue area and prevalent atrial fibrillation.

Exposure

Epicardial adipose tissue (EAT) area estimation via cardiac magnetic resonance imaging

Comparator

Patients without atrial fibrillation episodes

Outcome

Prevalent atrial fibrillation (AF)

Increased epicardial adipose tissue in patients with hypertrophic cardiomyopathy is independently associated with prevalent atrial fibrillation, potentially linked to autonomic dysregulation.

Main Result

Odds Ratio: 1.28 (95% CI 1.03–1.58)

p-value: p=0.03

Limitations

Autonomic nervous system activity was indirectly evaluated by an analysis of HRV parameters on Holter ECG recordings.
The exact mechanism by which initiators of AF are triggered via accumulation of EAT has not been elucidated.
Small number of prevalent AF cases with heterogeneous origins limited the ability to conduct specific subgroup analyses.
The sample primarily comprised middle-aged to elderly Japanese individuals, limiting generalizability to other ethnicities or age groups.
Confidence intervals for the association between AF and EAT area were wide due to limited statistical power.
Cystatin C level was not significantly correlated with AF episodes, possibly because of underpowering and small sample size.

Abstract

Prevalent atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) represents an important issue with regard to stroke events caused by embolization and is associated with high mortality. Increased epicardial adipose tissue (EAT), which shows high metabolic activity, can locally influence the activity of the autonomic ganglia, enhancing autonomic dysregulation and increasing the likelihood of AF. We tested the hypothesis that EAT is associated with prevalent AF in HCM patients. Sixty-two patients with idiopathic HCM diagnosed on the basis of ultrasound cardiography findings and histopathological evaluation of myocardium obtained by right ventricular biopsy underwent cardiac magnetic resonance imaging to estimate the extent of EAT. EAT area was significantly higher in the group with AF episodes than in the group without. An increased incidence of AF was found to be significantly related to an increase in EAT, and this association persisted after adjustment for body mass index, sex, and age. Time domain measures of heart rate variability measured by Holter electrocardiography, standard deviation of normal to normal, and standard deviation of the average of normal to normal were negatively related to EAT area. EAT was positively correlated with intraventricular septal thickness and cystatin C level and negatively correlated with the 24-hour creatinine clearance rate. Increased EAT area in HCM patients is significantly related to the presence of AF, which is associated with changes in baseline autonomic nervous tone, left ventricular mass, and chronic kidney disease.

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