Echocardiographically Measured Epicardial Fat Predicts New-onset Atrial Fibrillation after Cardiac Surgery

Gunturk, Ertugrul Emre; Topuz, Mustafa; Serhatlioğlu, Faruk; Akkaya, Hasan

doi:10.21470/1678-9741-2019-0388

Ertugrul Emre Gunturk

MD

Ömer Halisdemir University, Cardiology, Niğde, Turkey.

Mustafa Topuz Correspondence Address: Mustafa Topuz, https://orcid.org/0000-0002-6323-212X, Department of Cardiology, University of Health Science Adana City Education and Research Hospital, Adana, Turkey, Zip code: 01150. E-mail: topuzm46@gmail.com

MD

University of Health Sciences Adana City Education and Research Hospital, Cardiology Adana, Turkey,

https://orcid.org/0000-0002-6323-212X

Faruk Serhatlioğlu

MD

Ömer Halisdemir University, Cardiovascular Surgery, Niğde, Turkey.

Hasan Akkaya

MD

Ömer Halisdemir University, Cardiology, Niğde, Turkey.

Correspondence Address: Mustafa Topuz, https://orcid.org/0000-0002-6323-212X, Department of Cardiology, University of Health Science Adana City Education and Research Hospital, Adana, Turkey, Zip code: 01150. E-mail: topuzm46@gmail.com

No conflict of interest.

Figures (2)
Tables (5)

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Fig. 1
EAT was identified as an echo-free space between external myocardium and visceral pericardium from the parasternal long-axis view and was measured perpendicularly in front of the right ventricular free wall at end-diastole; AO=aorta; LA=left atrium; LV=left ventricle; RV=right ventricle

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Fig. 2
ROC analysis showed 67% sensitivity and 61% specificity for a cutoff value of 0.70 for EAT (P<0.001 area under the ROC curve: 0.890).

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Abbreviations, acronyms & symbols AF = Atrial fibrillation LAVI = Left atrial volume index CABG = Coronary artery bypass grafting LIMA = Left internal mammary artery CC = Cross-clamp NT Pro-BNP = N-terminal pro-brain natriuretic peptide CI = Confidence interval OR = Odds ratio CT = Computed tomography POAF = Postoperative atrial fibrillation CPB = Cardiopulmonary bypass ROC = Receiver operating characteristic EAT = Epicardial adipose tissue ROS = Reactive oxygen species ECG = Electrocardiography SPSS = Social Package for the Social Sciences LA = Left atrium TTE = Transthoracic echocardiography

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Table 1
Demographic, echocardiographic and laboratory characteristics of the study groups.

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Table 2
Correlation analysis of EAT thickness with study parameters in all study patients.

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Table 3
Univariate and multivariate logistic regression analysis showing parameters associated with POAF.

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Authors' roles & responsibilities EEG Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published MT Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published FS Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published HA Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published

Abbreviations, acronyms & symbols
AF	= Atrial fibrillation	LAVI	= Left atrial volume index
CABG	= Coronary artery bypass grafting	LIMA	= Left internal mammary artery
CC	= Cross-clamp	NT Pro-BNP	= N-terminal pro-brain natriuretic peptide
CI	= Confidence interval	OR	= Odds ratio
CT	= Computed tomography	POAF	= Postoperative atrial fibrillation
CPB	= Cardiopulmonary bypass	ROC	= Receiver operating characteristic
EAT	= Epicardial adipose tissue	ROS	= Reactive oxygen species
ECG	= Electrocardiography	SPSS	= Social Package for the Social Sciences
LA	= Left atrium	TTE	= Transthoracic echocardiography

		AF group (n=45)	Non-AF group (n=80)	P-value^* * A P<0.05 was accepted as significant.
Age, years, mean±SD		65.5±5.4	64.8±7.1	0.31
Male gender, n		28 (52.2%)	50 (62.5%)	0.97
Smoking, n		25 (55.5%)	41(51.2%)	0.64
BMI, kg/m², mean±SD		27.3±1.9	27.1±2.3	0.51
DM, n		18 (40.0%)	31(38.7%)	0.89
HT, n		33 (73.3%)	53 (66.2%)	0.41
COPD, n		5 (11.1%)	9 (11.2%)	0.98
Stroke, n		3 (6.7%)	6 (7.5%)	0.86
Previous MI, n		14 (31.1%)	30 (37.5%)	0.47
NYHA class (stages 1/2/3)		0/35/10	3/59/18	0.41
Heart rate, bpm		75.1±9.5	73.4±9.8	0.36
Laboratory characteristics	Glucose, mg/dl	97.6±9.7	98.4±9.5	0.51
	Creatinine, mg/dl	1.1±0.14	1.09±0.17	0. 6
	Sodium	140.1±2.8	140.7±2.7	0.97
	Potassium	4.4±0.6	4.5±0.5	0.15
	C-reactive protein, mg/dl	3.66±1.09	3.75±0.89	0.47
	Total-C, mg/dl	208.8±24.6	204.7 ±20.0	0.31
	LDL-C, mg/dl	135.7±21.5	132.2±19.4	0.32
	HDL-C, mg/dl	37.5±3.5	39.0±5.1	0.089
	TG, mg/dl	175.7±33.6	168.0±38.9	0.26
	TSH	2.6±0.57	2.6±0.49	0.94
	NT Pro-BNP, mg/dl	110.2±23.5	101.0±23.1	0.035
Surgery characteristics	Elective, n	37 (82.2%)	64 (80.0%)	0.76
	LIMA graft, n	36 (80.0%)	67 (83.7%)	0.59
	CC time, min	55.1±10.5	48.7±9.4	0.001
	CPB time, min	85.1±8.1	75.1±9.2	<0.001
	Total graft number, n	2.95±0.45	3.01±0.53	0.53
Echocardiography	LVEF, %	55.1±5.9	55.8±5.9	0.45
	LA diameter, mm	39.2±2.5	36.0±3.4	<0.001
	LA volume index	28.3±3.5	24.9±3.0	<0.001
	EAT thickness, mm	7.28±0.57	6.42±0.35	<0.001
Drugs	Beta-blockers, n	23 (51.1%)	39 (48.7%)	0.80
	ACE/ARB inhibitors, n	12 (26.7%)	29 (36.2%)	0.27
	Diuretics, n	25 (55.5%)	56 (70.0%)	0.10
	CCB, n	32 (71.1%)	61 (76.2%)	0.50
	Statins, n	22 (48.9%)	36 (45.0%)	0.67

	Correlation coefficient	P-value^* * A P<0.05 was accepted as significant.
Age	0.279	0.054
BMI	0.332	<0.001
Heart rate	0.07	0.83
C-reactive protein	0.155	0.303
NT Pro-BNP	0.11	0.51
TG	0.294	0.031
LDL-C	0.256	0.044
HDL-C	- 0.205	0.057
LA diameter	0.348	<0.001
LA volume index	0.316	0.012
CC time	0.342	<0.001
CPB time	0.309	<0.001

	Unadjusted OR/95%CI	P-value*	Adjusted OR/95%CI	P-value^* * A P<0.05 was accepted as significant.
Age	1.21(0.97-1.51)	0.090	1.22 (1.08-1.48)	0.048
NT ProBNP	1.07(0.94-1.21)	0.295	1.13(1.02-1.25)	0.014
LVEF	0.79(0.51-1.19)	0.266
LA	2.42(0.80-7.26)	0.115
LAVI	4.21(3.87-9.25)	0.303
EAT	3.11(2.07-4.25)	0.003	4.47(3.07-5.87)	0.001
Used graft	5.31(3.77-7.02)	0.03	4.71(2.88-5.76)	0.02
Statin	1.42(0.80-2.26)	0.02	1.37(0.88-1.86)	0.03
LIMA	1.39(0.05-31.57)	0.84
CC time	0.69(0.52-0.91)	0.001	0.73(0.52-0.92)	0.001
CPB time	2.17(1.33-3.23)	0.013	2.07(1.32-3.01)	0.001

Authors' roles & responsibilities
EEG	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
MT	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
FS	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
HA	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published

[1] Correspondence Address: Mustafa Topuz, https://orcid.org/0000-0002-6323-212X, Department of Cardiology, University of Health Science Adana City Education and Research Hospital, Adana, Turkey, Zip code: 01150. E-mail: topuzm46@gmail.com

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Echocardiographically Measured Epicardial Fat Predicts New-onset Atrial Fibrillation after Cardiac Surgery

Abstract

Objective:

Methods:

Results:

Conclusion: