Imaging-based epicardial adipose tissue assessment and serum adipokines in postoperative atrial fibrillation after coronary artery bypass grafting

Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. We evaluated the associations of preoperative epicardial adipose tissue thickness (EATT), measured by transthoracic echocardiography (TTE) and multislice computed tomography (MSCT), and circulating adipokines with POAF after isolated coronary artery bypass grafting (CABG), and compared the imaging methods. This prospective observational cohort included 96 consecutive eligible adults without prior atrial fibrillation who underwent elective isolated CABG. EATT was measured preoperatively by TTE and MSCT, and serum adiponectin, leptin, and resistin concentrations were determined. POAF was recorded during the first postoperative week. POAF occurred in 26 patients (27.1%). EATT measured by both methods was higher in patients who developed POAF. In multivariable analysis, EATT measured by TTE (odds ratio, 2.05; 95% confidence interval, 1.45–2.89; p < 0.001) and age (odds ratio, 1.08; 95% confidence interval, 1.00–1.156; p = 0.040) independently predicted POAF. The area under the curve was 0.818 for TTE (cutoff, 6.55 mm; sensitivity, 73.1%; specificity, 87.1%) and 0.787 for MSCT (cutoff, 6.22 mm; sensitivity, 80.8%; specificity, 75.7%), with no significant difference (p = 0.127). Bland–Altman analysis showed a mean bias of − 0.016 mm. Serum adipokine concentrations were not associated with POAF. Increased EATT and older age independently predicted POAF after isolated CABG. TTE showed performance comparable to MSCT and may provide a practical, radiation-free approach to preoperative EATT assessment. Larger multicenter studies are needed.