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Curso de Atualização em Medicina Cardiovascular 2019
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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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28. Risk Factors and Prevention
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32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Epicardial fat is more abundant in AF patients than controls and is a powerful predictor of relapse
Session:
CO2 - Arritmias Supraventriculares
Speaker:
Daniel Jorge Nascimento Matos
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.2 Atrial Fibrillation - Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Daniel Nascimento Matos; António Miguel Ferreira; Pedro Freitas; Sara Guerreiro; Gustavo Da Rocha Rodrigues; João Carmo; Maria Salomé Carvalho; João Abecasis; Ana Coutinho Santos; Pedro Lopes Do Carmo; Carla Rodrigues Carvalho; Diogo Cavaco; Francisco Bello Morgado; Miguel Mendes; Pedro Adragão
Abstract
<p><strong>Introduction: </strong></p> <p>Epicardial adipose tissue has been implicated in the pathophysiology of atrial fibrillation (AF), but its clinical relevance remains uncertain.</p> <p>The goals of this study were to assess the relationships between epicardial fat and: 1) the presence and severity of AF; 2) AF recurrence after percutaneous pulmonary vein isolation (PVI).</p> <p><strong>Methods:</strong></p> <p>We assessed 351 patients (139 men, age 61±13 years, 261 paroxysmal AF) with symptomatic AF undergoing cardiac CT prior to a first PVI procedure. Epicardial fat was quantified on contrast-enhanced images using a simplified semi-automated method.</p> <p>For the first goal, a subset of AF patients without coronary atherosclerosis (no plaque on CT) were matched on a 1:1 basis with patients without know AF undergoing CT for other reasons (but also with no coronary plaque). A propensity score was used to match individual patients for age, sex, body mass index (BMI) and major cardiovascular risk factors.</p> <p>For the second goal, the entire cohort of 351 AF patients was reviewed for recurrence of AF after PVI. Cox regression was used to assess the relationship between epicardial fat and AF relapse.</p> <p><strong>Results:</strong></p> <p>The propensity score yielded two groups of 86 patients each, well matched for baseline characteristics. Epicardial fat volume indexed to body surface area (BSA) was significantly higher in the AF group vs. controls (1.7±0.9 vs. 1.3±0.7 mL/m<sup>2</sup>, p=0.001). Among patients with AF, epicardial fat was more abundant in non-paroxysmal vs. paroxysmal AF (2.7±1.4 vs. 2.2±1.3 mL/m<sup>2</sup>, p=0.004). The correlation between epicardial fat volume and BMI was weak (Pearson’s R 0.34).</p> <p>Over a median follow-up of 15 months (IQR 7-23), 122 patients (35%) relapsed. Survival analysis showed significant differences in AF-free survival across tertiles of epicardial fat. After adjustment for BMI and other univariate predictors of relapse, three variables emerged independently associated with AF recurrence: non-paroxysmal AF (HR 2.45, 95%CI: 1.67-3.57, p<0.001), indexed left atrial volume (HR 1.24, 95%CI: 1.12-1.37, p<0.001), and indexed epicardial fat volume (HR 1.50, 95%CI: 1.32-1.71, p<0.001).</p> <p><strong>Conclusion:</strong></p> <p>Epicardial fat is more abundant in AF patients than in matched controls and is an independent predictor of relapse after percutaneous AF ablation. Both these findings suggest a clinically significant (and possibly causal) association between epicardial fat and the development and perpetuation of AF. The underlying mechanisms deserve further investigation.</p>
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