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

Figures & data

Table 1 The Clinical Characteristics and Pericardial Adipose Tissue Quantification in Men and Women

	All	Men	Women	P value
	2042	1128	914
Gender, %		55.2	44.8
Age, years	65.0 (64.5–65.6)	64.1 (63.4–64.9)	66.1 (65.5–66.8)	<0.001
AF, % (n)	8.5 (173)	9.8 (110)	6.9 (63)	0.013
Overweight, % (n)	38.9 (795)	41.2 (465)	36.1 (330)	0.020
Obesity, % (n)	12.0 (245)	13.1 (148)	10.6 (97)	0.047
Definite diabetes, % (n)	22.1 (451)	23.1 (261)	20.8 (190)	0.111
Definite hypertension, % (n)	57.5 (1174)	58.1 (655)	56.8 (519)	0.295
Smokers, % (n)	19.8 (403)	34.3 (387)	1.8 (16)	<0.001
Statin use, % (n)	7.6 (156)	8.2 (92)	7.0 (64)	0.186
Hypertension meds, % (n)	35.4 (722)	35.2 (397)	35.6 (325)	0.450
Hypoglycemic meds, % (n)	12.5 (255)	12.1 (137)	12.9 (118)	0.325
β-blocker, % (n)	5.1 (105)	6.1 (69)	3.9 (36)	0.039
Obstructive CAD, % (n)	35.3 (720)	42.1 (475)	26.8 (245)	< 0.001
CAC scores	205.7 (183.4–226,6)	254.1 (221.4–286.8)	144.4 (118.4–170.5)	< 0.001
BMI, kg/m^2	24.3 (24.1–24.4)	24.5 (24.4–24.7)	24.0 (23.8–24.2)	< 0.001
SBP, mmHg	135.5 (134.6–136.4)	135.5 (134.3–136.7)	135.6 (134.2–136.9)	0.949
Heart rate, beats/minute	77.4 (76.8–78.0)	77.7 (76.9–78.6)	77.0 (76.2–77.8)	0.234
Pericardial fat
EFV, cm^3	74.3 (72.9–75.6)	75.0 (73.1–76.8)	73.4 (71.5–75.3)	0.261
PaCFV, cm^3	42.5 (41.2–43.7)	47.9 (46.0–49.7)	35.8 (34.3–37.3)	< 0.001
PeCFV, cm^3	116.8 (114.5–119.1)	122.9 (119.5–126.2)	109.3 (106.3–112.2)	< 0.001
Perioaortic fat volume, cm^3	15.0 (14.6–15.4)	18.0 (17.4–18.6)	11.4 (11.0–11.8)	< 0.001
Echo parameters
LAD, cm	37.3 (37.1–37.6)	38.1 (37.7–38.4)	36.4 (36.1–36.8)	< 0.001
EF, %	63.3 (63.1–63.6)	62.4 (62.0–62.8)	64.5 (64.2–64.8)	< 0.001
Laboratory parameters
FG, mmol/L	5.89 (5.79–5.98)	6.00 (5.87–6.14)	5.74 (561–5.88)	0.008
TC, mmol/L	4.56 (4.51–4.61)	4.36 (4.29–4.42)	4.81 (4.74–4.88)	< 0.001
HDL-C, mmol/L	1.26 (1.24–1.28)	1.17 (1.15–1.19)	1.38 (1.35–1.41)	< 0.001
Creatinine, µmol/L	77.5 (75.1–79.9)	86.0 (82.5–89.5)	66.8 (63.7–70.0)	< 0.001

Note: Data are presented as mean (95% confidence interval, CI) for continuous or % (n) for categorical characteristics.

Abbreviations: AF, atrial fibrillation; CAD, coronary artery diseases; CAC, coronary artery calcium; BMI, Body mass index, kg/m²; SBP, systolic blood pressure, mmHg; EFV, epicardial fat tissue volume, cm³; PaCFV, paracardial fat tissue volume, cm³; PeCFV, pericardial fat tissue volume = PaCFV+EFV, cm³; PAFV, periaortic fat tissue volume, cm³; LAD, left atrial diameter, cm; EF, ejection fraction, %; FG, fasting glucose, mmol/L; TC, total cholesterol, mmol/L; HDL-C, high-density lipoprotein cholesterol, mmol.

Table 2 Atrial Fibrillation Risk Factors in Different Age and Genders

	Rheumatic HD % (n)	Other Valvular HD % (n)	Non-Valvular Risks % (n)
Age
Total, % (n)	11.6 (20)	8.7 (15)	79.8 (138)
<50 years	23.5 (4)	11.8 (2)	64.7 (11)
50–59 years	31.0 (9)	6.9 (2)	62.1 (18)
60–69 years	7.1 (4)	14.3 (8)	78.6 (43)
70–79 years	4.3 (2)	4.2 (2)	91.5 (44)
≥80 years	4.2 (1)	4.2 (1)	91.7 (22)
P value	0.041	0.176	0.009
Genders
Men	5.5 (6)	7.3 (8)	87.3 (96)
Women	22.2 (14)	11.1 (7)	66.7 (42)
P value	0.013	0.320	0.008

Note: Data are presented as % (n) for categorical variables.

Abbreviation: HD, heart disease.

Table 3 Pericardial Fat and Cardiometabolic Parameters in Non-Valvular AF and Patients without AF

	Non-AF	Non-Valvular AF	P value
	1868	138
Age, years	65.0 (64.5–65.5)	67.3 (65.3–69.3)	0.024
Pericardial fat
EFV, cm^3	73.6 (72.2–75.0)	84.0 (79.2–88.7)	<0.001
PaCFV, cm^3	42.3 (41.0–43.6)	46.0 (40.7–51.3)	0.141
PeCFV, cm^3	115.9 (113–118)	130.2 (121–139)	0.002
PAFV, cm^3	14.9 (14.5–15.3)	16.5 (14.9–18.1)	0.055
Echo
LAD, cm	36.6 (36.4–36.8)	43.0 (41.8–44.3)	<0.001
EF, %	63.6 (63.4–63.9)	60.6 (59.2–61.9)	<0.001
CAC scores	203.5 (180–226)	243.0 (158–327)	0.269
Obstructive CAD, % (n)	35.1 (656)	41.3 (57)	0.046
Cardiometabolic risks
BMI, kg/m^2	24.3 (24.1–24.4)	25.2 (24.6–25.7)	0.012
SBP, mmHg	135.7 (134–136)	136.5 (133–139)	0.627
Heart rate, beats/minute	77.0 (76.4–77.7)	80.3 (77.6–83.0)	0.003
FG, mmol/L	5.90 (5.80–6.00)	5.86 (5.45–6.28)	0.845
TC, mmol/L	4.58 (4.53–4.63)	4.29 (4.12–4.46)	0.013
HDL-C, mmol/L	1.27 (1.25–1.29)	1.16 (1.11–1.21)	0.007
Creatinine, µmol/L	77.2 (74.6–79.8)	82.0 (75.8–88.1)	0.332
Smokers, % (n)	19.5 (365)	23.9 (33)	0.130
Statin use, % (n)	7.3 (137)	13.8 (19)	0.012
Hypertension meds, % (n)	35.2 (657)	42.8 (59)	0.046
Hypoglycemic meds, % (n)	13.1 (244)	8.0 (11)	0.049
β-blocker, % (n)	5.0 (68)	8.7 (12)	0.052

Note: Data are presented as mean (95% confidence interval, CI) for continuous or % (n) for categorical characteristics.

Abbreviations: AF, atrial fibrillation; EFV, epicardial fat adipose tissue volume, cm³; PaCFV, paracardial fat adipose tissue volume, cm³; PeCFV, pericardial fat adipose tissue volume = PaCFV+EFV, cm³; PAFV, periaortic fat adipose tissue volume, cm³; LAD, left atrial diameter, cm; EF, ejection fraction, %; CAC, coronary artery calcium; CAD, coronary artery disease; BMI, body mass index, kg/m²; SBP, systolic hypertension, mmHg; FG, fast glucose, mmol/L; TC, total cholesterol, mmol/L; HDL-C, high-density lipoprotein cholesterol, mmol/L.

Table 4 Multivariate Logistic Regression Analysis of Epicardial Fat Volume and Atrial Fibrillation

Variables	OR (95% CI)	p-value
Model 1
EFV, cm^3	1.01 (1.00–1.02)	<0.001
Age	1.02 (1.00–1.04)	0.040
Gender	0.51 (0.35–0.74)	0.001
Model 2
EFV, cm^3	1.01 (1.00–1.02)	0.048
Age	1.02 (1.00–1.04)	0.047
Gender	0.57 (0.36–0.91)	0.019
BMI, kg/m^2	1.06 (1.00–1.13)	0.054
Hypertension, % (n)	1.02 (0.68–1.51)	0.923
Diabetes, % (n)	0.61 (0.37–1.00)	0.051
Smokers, % (n)	1.08 (0.67–1.73)	0.736
TC, mmol/L	0.82 (0.67–1.01)	0.058
HDL-C, mmol/L	0.64 (0.34–1.08)	0.054
Statin use, % (n)	0.85 (0.42–1.70)	0.650
Model 3
EFV, cm^3	1.00 (0.99–1.01)	0.234
Age	1.02 (1.00–1.04)	0.074
Gender	0.69 (0.41–1.13)	0.142
BMI, kg/m^2	1.03 (0.96–1.10)	0.379
Hypertension, % (n)	1.01 (0.65–1.55)	0.881
Diabetes, % (n)	0.60 (0.35–1.03)	0.066
Smokers, % (n)	1.11 (0.66–1.86)	0.687
TC, mmol/L	0.95 (0.77–1.17)	0.648
HDL-C, mmol/L	0.68 (0.34–1.19)	0.130
Statin use, % (n)	0.84 (0.37–1.87)	0.667
Obstructive CAD, % (n)	0.94 (0.67 −1.37)	0.108
LAD, cm	1.17 (1.12–1.22)	<0.001
EF, %	1.01 (0.98–1.04)	0.218

Abbreviations: EFV, epicardial fat adipose tissue volume; BMI, body mass index; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; CAD, coronary artery disease; LAD, left atrial diameter; EF, ejection fraction.

Table 5 CT-Derived Epicardial Fat Volume and Non-Valvular AF in Chinese Patients

	AF Cases/Total	Incident of AF, OR (95% CI)
		Model 1	Model 2	Model 3
Logistic Regression	138/2006	1.01 (1.00–1.02)	1.01 (1.00–1.02)	1.00 (0.99–1.01)
per Quartile*
Q1	19/502	Reference	Reference	Reference
Q2	26/501	1.43 (0.77–2.63)	1.38 (0.70–2.70)	1.35 (0.61–2.86)
Q3	36/501	1.89 (1.06–3.35)	1.69 (0.99–3.01)	1.56 (0.75–3.24)
Q4	57/502	3.01 (1.75–5.18)	2.64 (1.39–5.00)	2.13 (1.05–4.31)

Notes: Model 1: adjusted for age and sex. Model 2: as for model 1, additionally adjusted for body mass index, hypertension, smoking, diabetes, total cholesterol and high-density lipoprotein cholesterol, and use of lipid-lowering medication statins. Model 3: as for model 2, additionally adjusted for obstructive coronary artery disease and echocardiographic left atrial diameter and ejection fraction. *The ranges of epicardial fat volume per quartile were as follows: Q1: 14.9–53.1 cm³. Q2: 53.2–70.0 cm³. Q3: 70.0–91.3 cm³. Q4: 91.5–201.2 cm³.

Abbreviations: CT, computed tomography; AF, atrial fibrillation; OR, odds ratio; CI, confidence interval.