Epicardial adipose tissue volume is associated with prevalent atrial fibrillation in patients undergoing cardiac CT angiography: a retrospective observational case-control study

Q: What are the key findings of this study?

Epicardial adipose tissue volume was significantly higher in atrial fibrillation patients than controls (138.91 vs 93.57 mL, P<0.001) and independently associated with AF (OR 1.091, P=0.004).

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Atrial fibrillation (n=153). Intervention: Epicardial adipose tissue volume (EATV) measured by 256-slice spiral CCTA vs. Normal sinus rhythm control group (or lower EATV per 1 mL increment). Primary outcome: Prevalent atrial fibrillation (and mean EATV in AF vs control group) (OR 1.091, 95% CI 1.026–1.158, p=0.004).

Q: What does this research mean for the field?

Increased epicardial adipose tissue volume measured by cardiac CT angiography is independently associated with prevalent atrial fibrillation. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chen-Guang Kou; Yanfang Song; Caiying Li

doi:10.1186/s12880-026-03022-7

October 31, 2026BMC Medical ImagingOpen Access

Epicardial adipose tissue volume is associated with prevalent atrial fibrillation in patients undergoing cardiac CT angiography: a retrospective observational case-control study

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Key result

Higher epicardial adipose tissue volume is linked to ~9% higher odds of atrial fibrillation.

OR 1.091
95% CI 1.026–1.158
P=0.004
n=153

Why the study?

Epicardial adipose tissue contributes to AF development through its proinflammatory characteristics and proximity to the myocardium, prompting this evaluation of the correlation and clinical value of epicardial adipose tissue volume measured by cardiac computed tomographic angiography in AF.

Is epicardial adipose tissue volume measured by 256-slice spiral cardiac CT angiography independently associated with prevalent atrial fibrillation?

Key Points

To evaluate the correlation between epicardial adipose tissue volume measured by cardiac computed tomographic angiography and prevalent atrial fibrillation.
Retrospective observational case-control study enrolled 75 patients with AF (46 paroxysmal, 29 persistent; mean age 60.17±9.85 years) and 78 controls in sinus rhythm (mean age 59.93±10.49 years).
All patients underwent 256-slice spiral cardiac computed tomographic angiography (CCTA) to quantify epicardial adipose tissue volume (EATV) and pericardial adipose tissue volume (PATV) via workstation cardiac function software.
Patients with AF had significantly higher EATV compared with controls (138.91 ± 37.95 vs. 93.57 ± 34.81 mL, P < 0.001), though EATV did not differ significantly between paroxysmal and persistent AF subgroups (P = 0.617).
Multivariable logistic regression adjusting for cardiovascular covariates demonstrated that EATV was independently associated with AF (OR = 1.091, 95% CI: 1.026–1.158, P = 0.004).
Receiver operating characteristic analysis for EATV yielded an AUC of 0.823 (95% CI: 0.719–0.921, P < 0.001); an exploratory cutoff of 97.27 mL demonstrated 93.9% sensitivity and 61.5% specificity.

Study Design

Type

Case-Control (n=153)

Blinding

Single-blind (radiologist blinded to patients' AF status during measurements)

Multicenter

No

Structured PICO

Is epicardial adipose tissue volume measured by 256-slice spiral cardiac CT angiography independently associated with prevalent atrial fibrillation?

P

Population

153 patients (75 with paroxysmal or persistent atrial fibrillation and 78 sinus rhythm controls, mean age ~60 years, 45.1% female) undergoing 256-slice spiral cardiac CT angiography without prior heart failure, ablation, or heart surgery.

E

Exposure

256-slice spiral cardiac computed tomographic angiography (CCTA) with semi-automated volumetric quantification of epicardial adipose tissue volume (EATV) and pericardial adipose tissue volume (PATV)

C

Comparator

Control group of 78 patients in normal sinus rhythm undergoing 256-slice spiral CCTA for coronary artery evaluation, and internal subgroup comparison between paroxysmal AF (n=46) and persistent AF (n=29)

O

Outcome

Association between epicardial adipose tissue volume (EATV) and prevalent atrial fibrillationsurrogate

Main Result

Odds Ratio: 1.091 (95% CI 1.026–1.158)

Absolute Event Rate: 138.91% vs 93.57%

p-value: p=0.004

Quantitative epicardial adipose tissue volume measured by 256-slice spiral CCTA is independently associated with prevalent atrial fibrillation and demonstrates moderate discriminative capacity (AUC 0.823), although it does not significantly differ between paroxysmal and persistent AF subtypes.

Limitations

Relatively small sample size and retrospective single-center design, which may introduce case selection bias and limit intergroup comparability
Potential misclassification bias from undetected silent AF among controls
Semi-automated segmentation required manual delineation of the pericardial boundary without formal intra-observer or inter-observer reproducibility analysis
Incomplete medical records: definitive diabetes status could not be reliably ascertained (only fasting glucose available) and complete medication data were unavailable
Retrospective observational case-control study design
Small sample size of the persistent AF subgroup (n=29), limiting reliable conclusions regarding the association between EATV and AF subtypes
Potential confounding from baseline comorbidities (hypertension, diabetes mellitus, obesity), inconsistent duration of paroxysmal AF, and variable individual metabolic status
The EATV cutoff threshold (97.27 mL) is exploratory and derived from the same study sample without internal or external validation
Inherent limitation of ionizing radiation with 256-slice spiral CCTA

Implication

EATV by CCTA may aid prevalent AF identification; leaves open incremental value in prospective risk models.

Abstract

Background Atrial fibrillation (AF) is the most prevalent tachyarrhythmia in clinical practice and carries significant risks of disability and mortality. Epicardial adipose tissue (EAT) contributes to the development of AF owing to its proinflammatory characteristics and anatomical proximity to the myocardium. Purpose To explore the correlation between the epicardial adipose tissue volume (EATV) and AF and its clinical value by cardiac computed tomographic angiography (CCTA). Methods A total of 75 AF patients were enrolled and divided into 2 groups: paroxysmal AF group (n=46) and persistent AF group (n=29), there were 41 males and 34 females, with an average age of 60.17±9.85 years; In addition, 78 cases with sinus rhythm were also enrolled as control group, there were 43 males and 35 females, with an average age of 59.93±10.49 years. All enrolled patients received 256-slice spiral CCTA scanning, EATV and pericardial adipose tissue volume (PATV) were measured using cardiac function software in workstation, and basic information of all cases were recorded. EATV and other clinical data were compared between the AF group and the control group. EATV, PATV and other clinical data were further analyzed between the paroxysmal AF group and persistent AF group. Results AF group had higher EATV compared with control group (P<0.001). EATV and PATV in persistent AF group were slightly higher than those in paroxysmal AF group, but there was no significant difference between the two groups (P>0.05). There was a significant positive correlation between EATV and PATV in AF group (r=0.961, P<0.001). Logistic regression analysis indicated that EATV was independently associated with AF (OR = 1.091, 95% CI: 1.026–1.158, P = 0.004). The AUC of EATV to predict AF was 0.823 (P<0.001), When the cutoff value of EATV was 97.27 mL, the sensitivity and specificity of the diagnosis of AF were 93.9% and 61.5% respectively. Conclusion 256-slice spiral CCTA allows objective and quantitative measurement of EATV. Increased EATV is closely associated with prevalent AF. However, no significant difference in EATV was observed between different AF subtypes. EATV is an important imaging marker associated with prevalent AF in this retrospective observational case-control study.

Discussion

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Cite This Study

Kou et al. (2026) conducted a case-control in Atrial fibrillation (n=153). Epicardial adipose tissue volume (EATV) measured by 256-slice spiral CCTA vs. Normal sinus rhythm control group (or lower EATV per 1 mL increment) was evaluated on Prevalent atrial fibrillation (and mean EATV in AF vs control group) (OR 1.091, 95% CI 1.026–1.158, p=0.004). Epicardial adipose tissue volume was significantly higher in atrial fibrillation patients than controls (138.91 vs 93.57 mL, P<0.001) and independently associated with AF (OR 1.091, P=0.004).

synapsesocial.com/papers/6ae7d421edffb496294104bb https://doi.org/10.1186/s12880-026-03022-7

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Epicardial adipose tissue volume is associated with prevalent atrial fibrillation in patients undergoing cardiac CT angiography: a retrospective observational case-control study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Epicardial adipose tissue volume is associated with prevalent atrial fibrillation in patients undergoing cardiac CT angiography: a retrospective observational case-control study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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