Study On The Association Of Epicardial Adipose Tissue And Pericoronary Adipose Tissue With Atrial Fibrillation,atrial Fibrillation With Complications,and Recurrence After Catheter Ablation By Cardiac Computed Tomography

Part one Quantitative study of epicardial adipose tissue and peri- coronary adipose tissue in atrial fibrillation by cardiac computed tomography angiographyObjective: To quantify epicardial fat volume(EATV),epicardial fat density(EATD),pericoronary fat volume(PCATV)and fat suppression index(FAI)in atrial fibrillation and normal controls using cardiac computed tomography and to investigate the relationship between epicardial adipose tissue and pericoronary adipose tissue and the development of atrial fibrillation and to investigate its clinical value.Methods: A total of 217 patients with atrial fibrillation were collected in our hospital in the period from February 2020 to January 2021,including 120 men and 97 women with an average age of 61.49±8.49 years.the control group consisted of 24 men and 31 women with an average age of 59.49±7.80 years.General clinical data of the patients were recorded,including sex,age,height,weight,body mass index(BMI),hypertension,diabetes,total cholesterol(TC),triglycerides(TG).Cardiac computed tomography was performed in both groups with Philips 256-slice spiral CT.The original data was uploaded to the SIEMENS workstation,EATV and EATD were quantified.The original data was uploaded to the Shukun pericoronary fat intelligent evaluation system,PCAT volume and FAI of the three major coronary branches(LAD left anterior descending branch,LCX left circumflex branch,RCA right coronary artery)were quantified.Results:1.Comparison of general clinical data between atrial fibrillation group and control group: The age,sex,height,weight,body mass index(BMI),total cholesterol(TC),triglyceride(TG)in the atrial fibrillation group were no significant difference between two groups(P>0.05).2.Patients with atrial fibrillation had smaller RCA-PCATV than(P<0.05)the normal control group.The EATV of patients with atrial fibrillation was greater than that of the normal control group(P<0.05).There was no significant difference in EATD,LAD-PCATV,LCX-PCATV,LAD-FAI and LCX-FAI(P>0.05).3.Male group: RCA-PCATV of patients with the atrial fibrillation group was smaller than that of the normal control group(P<0.05).The EATV of patients with atrial fibrillation was greater than that of the normal control group(P<0.05).There was no significant difference in EATD,LAD-PCATV,LCX-PCATV,LAD-FAI,LCX-FAI and RCA-FAI(P>0.05).Female group:RCA-PCATV of patients with the atrial fibrillation group was smaller than that of the normal control group(P<0.05),There was no significant difference in EATV,EATD,LAD-PCATV,LCX-PCATV,LAD-FAI,LCX-FAI and RCA-FAI(P>0.05).4.The atrial fibrillation group was further divided into two groups according to sex.The LAD-FAI 、 LCX-FAI 、 RCA-FAI 、 EATD and RCA-PCATV in male group was higher than that in female patients(p<0.05).There was no significant difference in other indexes(P>0.05).5.The atrial fibrillation group was divided into two groups according to different ages(<65 years old group and≥65 years old group);EATV in less than 65 years old group were higher than those more than 65 years old group(P<0.05),There was no significant difference in other indexes(P>0.05).Conclusions: The epicardial adipose tissue and pericoronary adipose tissue can be measured quantitatively by using cardiac computed tomography CTA.They are important influencing factors for atrial fibrillation,and there are differences in gender and age.This study provides guidance for clinical doctors to evaluate the efficacy of atrial fibrillation,and has certain clinical value.Part two Quantitative study of epicardial adipose tissue and peri-coronary adipose tissue of atrial fibrillation patients with different complications by cardiac computed tomography angiographyObjective:Quantitatively measure the epicardial adipose tissue volume(EATV),epicardial adipose tissue density(EATD),pericoronary adipose tissue volume(PCATV)and fat attenuation index(FAI)in atrial fibrillation with different complications by cardiac computed tomography,and to explore the relationship between epicardial adipose tissue and pericoronary adipose tissue and the development of atrial fibrillation with different complications and to explore its clinical value.Methods: A total of 258 patients with atrial fibrillation in our hospital between February 2020 and January 2021 were collected,including 147 males and 111 females with an average age of 60.85±10.12 years.Patients were divided into groups according to whether they had hypertension,diabetes or coronary heart disease.The original data were transmitted to SIEMENS workstation,EATV and EATD were quantitatively measured.And the original data were transmitted to the Shukun pericoronary fat intelligent evaluation system,The PCAT volume and FAI of the three main branches of coronary artery(left anterior descending branch LAD,left circumflex branch LCX,right coronary artery RCA)were quantitatively measured.Above related parameters were compared between the atrial fibrillation patients with or without complications,the measurement indexes were statistically analyzed.Results:1.Comparison of PCAT and EAT between the atrial fibrillation with hypertension presence group and the atrial fibrillation without hypertension presence group: The EATD in atrial fibrillation with hypertension group was higher than that in atrial fibrillation without hypertension group(P<0.05).There was no significant difference in other indexes.2.Comparison of PCAT and EAT between the atrial fibrillation with diabetes mellitus presence group and the atrial fibrillation without diabetes mellitus presence group: The EATD in atrial fibrillation with diabetes mellitus group was higher than that in atrial fibrillation without diabetes mellitus group(P<0.05).There was no significant difference in other indexes.3.Comparison of PCAT and EAT between the atrial fibrillation with coronary artery disease presence group and the atrial fibrillation without coronary artery disease presence group: The EATV in atrial fibrillation with coronary artery disease group was higher than that in atrial fibrillation without coronary artery disease group(P<0.05).There was no significant difference in other indexes.Conclusions: The volume and density of epicardial adipose tissue is an important predictor of cardiovascular risk factors in patients with atrial fibrillation.Pericoronary adipose tissue has no significant effect on atrial fibrillation with or without complications.This study may help in the stratified clinical management of patients with atrial fibrillation with various complications and predict the prognosis in different patients.Part three Association of pericoronary adipose tissue with atrialfibrillation recurrence after ablation based on cardiac computed tomography angiographyObjective: Quantitative measurement of pericoronary adipose tissue volume(PCATV)and fat attenuation index(FAI)has mostly been used in the study of coronary artery related diseases but rarely in the relationship with atrial fibrillation(AF).This study was conducted to investigate the correlation of PCATV and FAI with the AF recurrence after ablation and the clinical significance.Methods:A retrospective analysis of 189 patients with AF who underwent left atrium and pulmonary vein imaging with 256-slice computed tomography before catheter ablation(CA),including 105 males and 84 females with an average age of 63(56,66)years.After 12-month follow-up with a mean follow-up time of 10.93±0.16 months,47(24.9%)patients were confirmed to have AF recurrence.The PCATV,FAI,epicardial adipose tissue volume(EATV)and EAT density(EATD)arround the three main branches of the coronary arteries(LAD,LCX,and RCA)were measured quantitatively with cardiac function software and analyzed.Results:1.No significant differences existed in the age,sex,type and duration of AF,BMI,hypertension,diabetes mellitus,coronary artery disease,stroke/transient ischemic attack,drinking,smoking,medication history,laboratory tests,and ultrasound parameters between the recurrence and non-recurrence groups(P>0.05).2.The EATV in patients with recurrence was higher than the non-recurrence group(P<0.05).After the body surface area standardized of the measurement indexes,The EATVI in patients with recurrence was higher than the non-recurrence group(P<0.05).The 3V-FAI,LCX-FAI were significantly increased in the recurrence group(P<0.05).3.EATVI(OR:1.043,95% CI 1.020-1.066)and LCX-FAI(OR 1.254,95% CI 1.145-1.374)were two significant independent risk factors for AF recurrence.In the comparison of ROC,the predictive value of LCX-FAI(cut-off value of>-81.5 HU,AUC of 0.722)was higher than that of EATVI(cut-off value > 81.07 ml/m2,AUC of 0.630).Conclusions: The EATVI and LCX-FAI were related to recurrence of AF after ablation and have important clinical value in predicting the AF recurrence.