A Stronger Association of Epicardial Fat Volume with Non-Valvular Atrial Fibrillation Than Measures of General Obesity in Chinese Patients Undergoing Computed Tomography Coronary Angiography

Jingqi Zhu; Zhangwei Yang; Xiaoli Chen; Jie Liu; Liang Zheng; Lin Zhang; Jingjiang Pi; Gang Li; Tao Zhuang; Chang Liu; Yinglu Wang; Liping Liu; Lieying Fan; Paul Chan; Brian Tomlinson; Ying Li; Zhongmin Liu; Yuzhen Zhang

doi:10.2147/DMSO.S274047

A Stronger Association of Epicardial Fat Volume with Non-Valvular Atrial Fibrillation Than Measures of General Obesity in Chinese Patients Undergoing Computed Tomography Coronary Angiography

Diabetes Metab Syndr Obes. 2021 Mar 18:14:1223-1232. doi: 10.2147/DMSO.S274047. eCollection 2021.

Authors

Jingqi Zhu^#^{1

2}, Zhangwei Yang^#², Xiaoli Chen^#³, Jie Liu³, Liang Zheng³, Lin Zhang³, Jingjiang Pi⁴, Gang Li², Tao Zhuang³, Chang Liu³, Yinglu Wang³, Liping Liu³, Lieying Fan⁵, Paul Chan⁶, Brian Tomlinson⁷, Ying Li⁴, Zhongmin Liu³, Yuzhen Zhang³

Affiliations

¹ Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
² Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
³ Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
⁴ Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
⁵ Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
⁶ Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁷ Faculty of Medicine, Macau University of Science and Technology, Macau, People's Republic of China.

^# Contributed equally.

Abstract

Objective: An association of atrial fibrillation (AF) with epicardial fat volume (EFV) varied in different ethnic groups. We evaluated the AF-related risk factors and its association with pericardial fat in Chinese patients.

Methods: Patients referred for coronary computed tomography angiography (CCTA) in Shanghai East Hospital during 2012 to 2014 (n=2042, 43.8% women, mean age 65.0 years) had AF and cardiovascular risk assessment. Pericardial fat depots were measured from CT and the association of EFV with non-valvular AF risk factors was evaluated by multivariate logistic regression models.

Results: AF was present in 8.5% of patients with 11.6% of AF patients having rheumatic heart disease (RHD) and 8.7% having other valvular diseases. With increasing age, the proportion of RHD-related AF decreased and the risk factors for non-valvular AF increased. There was a significantly higher proportion of risk factors for non-valvular AF in men than in women (p=0.008), but RHD-related AF was more prevalent in women than men (p=0.013). The patients with non-valvular AF had significantly higher BMI and EFV with more pronounced elevation of EFV (p<0.001). Multivariate logistic regression showed a significant association of EFV with AF after adjustment for BMI and clinical risk factors, and the highest EFV quartile was associated with AF independent of left atrial size and obstructive coronary artery disease.

Conclusion: The association of EFV with non-valvular AF in Chinese patients was independent of generalized adiposity and clinical risk factors especially in highest EFV quartile. These findings support the growing appreciation of the association of EFV with AF.

Keywords: atrial fibrillation; body mass index; computed tomography; echocardiography; epicardial fat; obesity; pericardial fat.

Grants and funding

This study is supported by the funds from the Science and Technology Commission of Shanghai Municipality (19411965300, 17431906600), Top-level Clinical Discipline Project of Shanghai Pudong District Grant (PWYgf2018-02), the National Natural Science Foundation of China (81770259, 81970232, 81970233, 81970234, 81800253, 81770094, 81870202), the Health System Academic Leader Training Plan of Pudong District Shanghai (PWRd2018-06), and the Fundamental Research Funds for the Central Universities (22120180380).