Key result
Indexed pericardial fat volume is linked to ~55% higher AF recurrence risk after PVI.
Why the study?
Epicardial adipose tissue has been implicated in AF pathophysiology, but its clinical relevance for predicting AF relapse after PVI remains uncertain.
Does epicardial fat volume outperform clinical scores in predicting AF relapse after pulmonary vein isolation in patients with symptomatic AF?
Cohort (n=575)
Does epicardial fat volume outperform clinical scores in predicting AF relapse after pulmonary vein isolation in patients with symptomatic AF?
Hazard Ratio: 1.55 (95% CI 1.43–1.67)
p-value: p=<0.001
Epicardial fat volume measured by cardiac CT is a strong independent predictor of AF relapse after PVI, outperforming traditional clinical risk scores.
Epicardial fat quantification may refine post-PVI relapse prediction beyond clinical scores; hypothesis-generating for improved stratification in observational data.
Background Epicardial adipose tissue has been implicated in the pathophysiology of atrial fibrillation (AF), but its relevance to clinical practice remains uncertain. The aim of this study was to compare the performance of the amount of epicardial fat with previously published clinical scores of AF-relapse risk after pulmonary vein isolation (PVI). Methods We assessed 575 patients (354 men, age 61±11 years, 449 paroxysmal AF) with symptomatic AF undergoing cardiac CT prior to a PVI procedure. Epicardial fat was quantified on contrast-enhanced images using a new simplified semi-automated method. The study endpoint was symptomatic and/or documented AF recurrence at 12 months. Epicardial fat was compared against the following scores: MB-LATER, APPLE, DR-FLASH, and ATLAS. Results Median follow-up was of 22 months (IQR 12–35), 232 patients relapsed, 130 patients (27%) within the first 12 months. After adjustment for BMI and other univariate predictors of relapse, three variables emerged independently associated with time to AF recurrence: non-paroxysmal AF (HR 2.03, 95% CI: 1.53–2.69, p<0.001), indexed left atrial (LA) volume (HR 1.02 per mL/m2, 95% CI: 1.01–1.02, p<0.001), and indexed pericardial fat volume (HR 1.55 per mL/m2, 95% CI: 1.43–1.67, p<0.001). Based on the ROC curve analysis, the epicardial fat showed greater discriminative power, with a C-statistic of 0.76 (95% CI: 0.71–0.81) against 0.67 (p=0.007 for pairwise comparison of ROC curves), 0.67 (p=0.01), 0.63 (p<0.001) and 0.57 (p<0.001) for the MBLATER, APPLE, DR-FLASH and ATLAS scores, respectively. The C-statistic for indexed LA volume and non-paroxysmal AF AUC were of 0.63 (p<0.001) and 0.61 (p<0.001), respectively. Conclusion Pericardial fat volume is a strong independent predictor of AF relapse after PVI, outperforming clinical scores of post-PVI AF. The underlying mechanisms of this association deserve further study. ROC Curve Analysys Funding Acknowledgement Type of funding source: None
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Matos et al. (2020) conducted a cohort in Atrial fibrillation (n=575). Epicardial fat volume vs. Clinical scores (MB-LATER, APPLE, DR-FLASH, ATLAS) was evaluated on Time to symptomatic and/or documented AF recurrence (HR 1.55, 95% CI 1.43-1.67, p=<0.001). Indexed pericardial fat volume independently predicted atrial fibrillation recurrence after pulmonary vein isolation (HR 1.55 per mL/m2; 95% CI 1.43-1.67; p<0.001), outperforming clinical scores.
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