Excessive interatrial adiposity is associated with left atrial remodeling, augmented contractile performance in asymptomatic population

Lai, Yau‐Huei; Yun, Chun Ho; Su, Cheng‐Huang; Yeh, Hung I.; Hou, Charles Jia Yin; Wu, Tung Hsin; Cury, Ricardo C.; Bezerra, Hiram G.; Hung, Chung‐Lieh

doi:10.1530/erp-15-0031

Cited by 11 publications

(6 citation statements)

References 40 publications

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“…Similar changes were found in adult patients with interatrial adiposity. These remodeling processes were associated with increased LA global kinetic energy and ejection force at the hemodynamic level, which may serve to compensate for functional LA deterioration in asymptomatic patients [ 10]. It is hoped that these changes are not significant for the lives of our young patients.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Shape and Function After Endovascular Device and Surgical Closure of Asds in Children

Сморгон¹,

Anatolievich²,

Ivanovich³

et al. 2022

Preprint

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Retrospective analysis of echocardiograms was performed in 756 children who received endovascular device or surgical ASD closure from 2006 to 2016 in the Cardiac Center in Tomsk Russia. 564 patients had an endovascular closure and 192 had surgical correction. Follow-up duration was from 1 day to 10 years, mean 3.6 yrs for the device group and 4.2 yrs for the surgery group. The control group consisted of 3393 age-matched healthy patients. In patients with endovascular closure of an ASD, 35% had a change in the shape of the left atrium in early follow-up. Changes in the shape of the left atrium at early follow-up were more often observed in the device group and in children of a younger age. The left atrial changes were a decrease in sphericity and an increase in ellipsoidy. Changes in the shape of the left atrium persisted in 22% after transcatheter correction in the long-term. The change in shape of the left atrium after the placement of ASD devices was accompanied by activation of the mechanical function of the atrium and an increase in the filling pressure of the left ventricle. These changes were not accompanied by any disturbance in the contractility and volume of the heart chambers. In the group with surgical correction of ASD, the contractility and volume of the heart chambers did not significantly differ from those in the device closure group.

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Section: Discussionmentioning

confidence: 99%

Left Atrial Shape and Function After Endovascular Device and Surgical Closure of Asds in Children

Сморгон¹,

Anatolievich²,

Ivanovich³

et al. 2022

Preprint

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“…Furthermore, a great body of literatures have also demonstrated direct and local negative impacts on myocardial tissue from VAT through elicited oxidative stress and several pathological pro‐inflammatory mechanisms with excessive LA interstitial fibrotic replacement, causing ‘atrial myopathy’ prone to AF onset or perpetuation, 6,13,19,33 leading to HFpEF/AF development 33,34 . Indeed, independent pathological links were observed between abundant epicardial adiposity and structural atrial dilation 35 or subclinical impaired LA mechanics by either speckle‐tracking or MRI assessment 14,36,37 . However, these studies were limited by relatively small number and lack of comprehensive LA measures or follow‐up data.…”

Section: Discussionmentioning

confidence: 99%

Associations of region‐specific visceral adiposity with subclinical atrial dysfunction and outcomes of heart failure

et al. 2020

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Aims Excessive visceral adiposity (VAT) plays an essential role in metabolic derangements with those close to heart further mediates myocardial homeostasis. The disparate biological links between region-specific VAT and cardiometabolic profiles as mediators influencing atrial kinetics remain unexplored. Methods and results Among 1326 asymptomatic individuals, region-specific VAT including peri-aortic root fat (PARF) and total pericardial fat (PCF) of cardiac region, together with thoracic peri-aortic adipose tissue (TAT), was assessed using multiple-detector computed tomography. VAT measures were related to functional left atrial (LA) metrics assessed by speckle-tracking algorithm and clinical outcomes of atrial fibrillation (AF) and heart failure (HF). Multivariate linear regression models incorporating body fat, metabolic syndrome, and E/TDI-e' consistently demonstrated independent associations of larger PARF/PCF with peak atrial longitudinal systolic strain (PALS) reduction, higher LA stiffness, and worsened strain rate components; instead, TAT was independently associated with cardiometabolic profiles. PARF rather than PCF or TAT conferred independent prognostic values for incident AF/HF by multivariate Cox regression (adjusted hazard ratio: 1.56, 95% confidence interval: 1.17-2.08, P = 0.002) during a median of 1790 days (interquartile range: 25th to 75th: 1440-1927 days) of follow-up, with subjects categorized into worst PALS and largest VAT tertiles demonstrating highest events (all log-rank P < 0.001). Mediation analysis showed that higher triglyceride and lower high-density lipoproteins may serve as intermediary factors for effects between VAT and LA functional metrics, with lesser role by glucose level. Conclusions Visceral adiposity surrounding atrial region was tightly associated with subclinical atrial dysfunction and incident AF or HF beyond metabolic factors. Instead, peri-aortic adiposity may mediate their toxic effects mainly through circulating cardiometabolic profiles.

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“…Therefore, it is possible that the greater fat depots around the LA in AF patients would be accompanied by a decreased reservoir function through augmented LA kinetic energy and the ejection force. In fact, it has been suggested that regional adipose tissues can be beneficial by preserving myocardial energy supply under certain circumstances, yet simultaneously impose certain negative effects generated by the inflammatory process . Conversely, the maintenance of sinus rhythm after ablation improves the atrial contractile function, and reduces the atrial oxygen consumption and coronary flow.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, it has been suggested that regional adipose tissues can be beneficial by preserving myocardial energy supply under certain circumstances, yet simultaneously impose certain negative effects generated by the inflammatory process. 36 Conversely, the maintenance of sinus rhythm after ablation improves the atrial contractile function, and reduces the atrial oxygen consumption and coronary flow. These myocardial conditions would decrease the LA myocardium's energy supply and negative effects of the inflammatory process.…”

Section: Influence Of Eat On Ablation Outcomementioning

confidence: 99%

Effect of epicardial fat and metabolic syndrome on reverse atrial remodeling after ablation for atrial fibrillation

Monno

Okumura

Saito

et al. 2018

Journal of Arrhythmia

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BackgroundMetabolic syndrome/epicardial adipose tissue (EAT) plays an important role in atrial fibrillation (AF). Although reverse atrial remodeling (RAR) often occurs after AF ablation, the effects of EAT on RAR remain unknown.MethodsStudy subjects were 104 patients in whom transthoracic echocardiography (TTE) was performed before AF ablation and 3, 6, and 12 months afterward. EAT was assessed in terms of its thickness adjacent to the right ventricular anterior wall in the TTE parasternal view. RAR was defined as >10% reduction in the left atrial volume (LAV) index by the 3‐month follow‐up examination.ResultsPostablation RAR occurred in 57/104 (55%) patients. RAR absence was associated with a relatively thick EAT (4.92 ± 1.65 vs. 3.92 ± 1.17 mm, P = 0.0005), small LAV index (24.6 ± 7.5 vs. 28.8 ± 10.6 mL/m2, P = 0.0233), and metabolic syndrome (62% vs. 28%, P = 0.0006). Metabolic syndrome and EAT were shown to be independent predictors of RAR absence. Thick EAT was significantly associated with AF recurrence after ablation (5.05 ± 2.19 mm vs. 4.17 ± 1.16 mm for no AF recurrence group, P = 0.0116), but metabolic syndrome was not (48% vs. 42%, P = 0.6189). Despite no change in body weight, EAT thickness decreased significantly by 12 months in patients without AF recurrence (4.17 ± 1.16 vs. 3.65 ± 1.16 mm, P < 0.0001).Conclusions EAT and metabolic syndrome appear to be strongly associated with RAR absence, but only the thick EAT was significantly associated with the postablation AF recurrence. Our findings, especially the thinning of EAT, suggest that thick EAT lead to AF vulnerability but that EAT reduction favorably affects ablation outcome.

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Excessive interatrial adiposity is associated with left atrial remodeling, augmented contractile performance in asymptomatic population

Cited by 11 publications

References 40 publications

Left Atrial Shape and Function After Endovascular Device and Surgical Closure of Asds in Children

Left Atrial Shape and Function After Endovascular Device and Surgical Closure of Asds in Children

Associations of region‐specific visceral adiposity with subclinical atrial dysfunction and outcomes of heart failure

Effect of epicardial fat and metabolic syndrome on reverse atrial remodeling after ablation for atrial fibrillation

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