The correlation between left atrial fat gray value and the prognosis of patients with atrial fibrillation treated by thoracoscopic radiofrequency ablation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CUI Yan ¹ , LI Haojie ² , DU Juan ¹ , SHI Ye ¹ , ZOU Liang ¹ , CHEN Yi ¹ , ZHANG Zhipeng ¹ , XU Danqing ¹ , YANG Limeng ¹ , HOU Zhihui ³ , HOU Jianfeng ² , YAO Yan ⁴ ,  ZHENG Zhe ²

1. Department of SICU, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;
2. Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;
3. Department of Medical Image Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;
4. Department of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

ZHENG Zhe, Email: zhengzhe@fuwai.com

Keywords：

Atrial fibrillation; thoracoscopic surgery; radiofrequency ablation; epicardial fat

DOI：

10.7507/1007-4848.202005044

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Objective To analyze the correlation between the gray value of epicardial fat and the prognosis of patients with atrial fibrillation (AF) treated by thoracoscopic radiofrequency ablation.Methods The clinical data of 97 patients, including 75 males and 22 females with an average age of 57.8±9.4 years, who underwent thoracoscopic radiofrequency ablation in Fuwai Hospital from 2017 to 2018 were analyzed retrospectively. The left atrial fat volume and average gray scale were calculated by left atrial enhanced CT. According to the average gray scale of left atrial fat tissue, the patients were divided into three groups: a high gray scale group, a medium gray scale group and a low gray scale group. The patients were followed up at 3, 6 and 12 months after operation. The end point of follow-up was the recovery rate of sinus rhythm. Survival analysis was used to analyze the correlation between CT features of epicardial fat enhancement and prognosis.Results After adjustment of body mass index, body surface area, gender and left atrial end diastolic diameter, regression analysis showed that the fat gray of left atrial enhanced CT was correlated with the type of AF (OR=0.30, 95%CI 0.12-0.79, P=0.014). Cox regression analysis showed that the fat gray value of left atrial CT predicted the recurrence of AF after thoracoscopic radiofrequency ablation (OR=0.92, 95%CI 0.85-0.99). The Kaplan-Meier curve showed significant difference in the long-term recurrence rate of AF among the three groups (P=0.011). The lower left atrial fat enhanced CT gray scale was, the higher long-term recurrence rate of AF was.Conclusion The gray value of left atrial fat enhanced CT can effectively predict the recurrence of AF after radiofrequency ablation in thoracoscopic surgery.

Citation： CUI Yan, LI Haojie, DU Juan, SHI Ye, ZOU Liang, CHEN Yi, ZHANG Zhipeng, XU Danqing, YANG Limeng, HOU Zhihui, HOU Jianfeng, YAO Yan, ZHENG Zhe. The correlation between left atrial fat gray value and the prognosis of patients with atrial fibrillation treated by thoracoscopic radiofrequency ablation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(7): 806-810. doi: 10.7507/1007-4848.202005044 Copy

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2.	Wong CX, Abed HS, Molaee P, et al. Pericardial fat is associated with atrial fibrillation severity and ablation outcome. J Am Coll Cardiol, 2011, 57(17): 1745-1751.
3.	Antonopoulos AS, Sanna F, Sabharwal N, et al. Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med, 2017, 9(398): eaal2658.
4.	Mahabadi AA, Lehmann N, Kälsch H, et al. Association of epicardial adipose tissue and left atrial size on non-contrast CT with atrial fibrillation: The Heinz Nixdorf Recall Study. Eur Heart J Cardiovasc Imaging, 2014, 15(8): 863-869.
5.	Ciuffo L, Nguyen H, Marques MD, et al. Periatrial fat quality predicts atrial fibrillation ablation outcome. Circ Cardiovasc Imaging, 2019, 12(6): e008764.
6.	郑哲, 姚焰, 李浩杰, 等. 外科和介入复合治疗难治性心房颤动初步经验. 中国循环杂志, 2017, 32(4): 362-366.
7.	Hatem SN, Sanders P. Epicardial adipose tissue and atrial fibrillation. Cardiovasc Res, 2014, 102(2): 205-213.
8.	Thanassoulis G, Massaro JM, O'Donnell CJ, et al. Pericardial fat is associated with prevalent atrial fibrillation: The Framingham heart study. Circ Arrhythm Electrophysiol, 2010, 3(4): 345-350.
9.	Batal O, Schoenhagen P, Shao M, et al. Left atrial epicardial adiposity and atrial fibrillation. Circ Arrhythm Electrophysiol, 2010, 3(3): 230-236.
10.	Nagashima K, Okumura Y, Watanabe I, et al. Does location of epicardial adipose tissue correspond to endocardial high dominant frequency or complex fractionated atrial electrogram sites during atrial fibrillation? Circ Arrhythm Electrophysiol, 2012, 5(4): 676-683.
11.	Tsao HM, Hu WC, Wu MH, et al. Quantitative analysis of quantity and distribution of epicardial adipose tissue surrounding the left atrium in patients with atrial fibrillation and effect of recurrence after ablation. Am J Cardiol, 2011, 107(10): 1498-1503.
12.	Nagashima K, Okumura Y, Watanabe I, et al. Association between epicardial adipose tissue volumes on 3-dimensional reconstructed CT images and recurrence of atrial fibrillation after catheter ablation. Circ J, 2011, 75(11): 2559-2565.
13.	Oikonomou EK, Williams MC, Kotanidis CP, et al. A novel machine learning-derived radiotranscriptomic signature of perivascular fat improves cardiac risk prediction using coronary CT angiography. Eur Heart J, 2019, 40(43): 3529-3543.

1. Krul SP, Driessen AH, Zwinderman AH, et al. Navigating the mini maze: Systematic review of the first results and progress of minimally invasive surgery in the treatment of atrial fibrillation. Int J Cardiol, 2013, 166(1): 132-140.
2. Wong CX, Abed HS, Molaee P, et al. Pericardial fat is associated with atrial fibrillation severity and ablation outcome. J Am Coll Cardiol, 2011, 57(17): 1745-1751.
3. Antonopoulos AS, Sanna F, Sabharwal N, et al. Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med, 2017, 9(398): eaal2658.
4. Mahabadi AA, Lehmann N, Kälsch H, et al. Association of epicardial adipose tissue and left atrial size on non-contrast CT with atrial fibrillation: The Heinz Nixdorf Recall Study. Eur Heart J Cardiovasc Imaging, 2014, 15(8): 863-869.
5. Ciuffo L, Nguyen H, Marques MD, et al. Periatrial fat quality predicts atrial fibrillation ablation outcome. Circ Cardiovasc Imaging, 2019, 12(6): e008764.
6. 郑哲, 姚焰, 李浩杰, 等. 外科和介入复合治疗难治性心房颤动初步经验. 中国循环杂志, 2017, 32(4): 362-366.
7. Hatem SN, Sanders P. Epicardial adipose tissue and atrial fibrillation. Cardiovasc Res, 2014, 102(2): 205-213.
8. Thanassoulis G, Massaro JM, O'Donnell CJ, et al. Pericardial fat is associated with prevalent atrial fibrillation: The Framingham heart study. Circ Arrhythm Electrophysiol, 2010, 3(4): 345-350.
9. Batal O, Schoenhagen P, Shao M, et al. Left atrial epicardial adiposity and atrial fibrillation. Circ Arrhythm Electrophysiol, 2010, 3(3): 230-236.
10. Nagashima K, Okumura Y, Watanabe I, et al. Does location of epicardial adipose tissue correspond to endocardial high dominant frequency or complex fractionated atrial electrogram sites during atrial fibrillation? Circ Arrhythm Electrophysiol, 2012, 5(4): 676-683.
11. Tsao HM, Hu WC, Wu MH, et al. Quantitative analysis of quantity and distribution of epicardial adipose tissue surrounding the left atrium in patients with atrial fibrillation and effect of recurrence after ablation. Am J Cardiol, 2011, 107(10): 1498-1503.
12. Nagashima K, Okumura Y, Watanabe I, et al. Association between epicardial adipose tissue volumes on 3-dimensional reconstructed CT images and recurrence of atrial fibrillation after catheter ablation. Circ J, 2011, 75(11): 2559-2565.
13. Oikonomou EK, Williams MC, Kotanidis CP, et al. A novel machine learning-derived radiotranscriptomic signature of perivascular fat improves cardiac risk prediction using coronary CT angiography. Eur Heart J, 2019, 40(43): 3529-3543.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The correlation between left atrial fat gray value and the prognosis of patients with atrial fibrillation treated by thoracoscopic radiofrequency ablation

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