The Association between Atrium Electromechanical Interval and Pericardial Fat

Abstract

ObjectivesPericardial fat (PCF) may induce local inflammation and subsequent structural remodeling of the left atrium (LA). However, the adverse effects of PCF on LA are difficult to be evaluated and quantified. The atrial electromechanical interval determined by transthoracic echocardiogram was shown to be a convenient parameter which can reflect the process of LA remodeling. The goal of the present study was to investigate the association between the electromechanical interval and PCF.Methods and ResultsA total of 337 patients with mean age of 51.9±9.0 years were enrolled. The electromechanical interval (PA-PDI) defined as the time interval from the initiation of the P wave deflection to the peak of the mitral inflow A wave on the pulse wave Doppler imaging was measured for every patient. The amount of PCF was determined by multi-detector computed tomography. The PA-PDI interval was significantly correlated with the amount of PCF (r = 0.641, p value <0.001). Graded prolongation of PA-PDI interval was observed across 3 groups of patients divided according to the tertile values of PCF. The AUC for the PA-PDI interval in predicting an increased amount of PCF (third tertile) was 0.796. At a cutoff value of 130 ms identified by the ROC curve, the sensitivity and specificity of PA-PDI interval in identifying patients with a highest tertile of PCF were 63.4% and 85.3%, respectively.ConclusionsThe PA-PDI intervals were longer in patients with an increased amount of PCF. It may be a useful parameter to represent the degree of PCF-related atrial remodeling.

Impact of obesity and epicardial fat on early left atrial dysfunction assessed by cardiac MRI strain analysis

“…Further data regarding other ultra-structural analysis (e.g. from diffusion tensor imaging [30], T1 mapping [31], biochemical changes [32], or even electrophysiology [33]) may be helpful in extending the characterisation of LV structural changes in early diastolic dysfunction.…”

The Associations between Various Ectopic Visceral Adiposity and Body Surface Electrocardiographic Alterations: Potential Differences between Local and Remote Systemic Effects

“…In addition, both excessive PCF and TAT added significant incremental values in identifying abnormally long PR interval beyond BMI. While obesity had been recognized to be associated with atrial electrical remodeling (such as widening P wave or prolonged PR interval) and a major risk for AF through local or systemic influences [ 33 ], the independent link between larger PCF/TAT and PR prolongation beyond BMI further support the possible role of excessive visceral adiposity in AF substrate formation [ 7 – 10 ]. Nevertheless, the possible mechanisms underlying these relationships may be somewhat different between PCF and TAT, with PCF presumably mediates its role through local effect owing to its unique anatomy exclusively encased within pericardial sac adjacent to myocardium [ 31 , 34 ].…”

“…More recently, there is a growing body of literature has demonstrated that PCF may alter atrial electrical features, and the burden of PCF is tightly linked to atrial fibrillation (AF) incidence [ 7 – 9 ]. The underlying mechanisms were more likely to be associated with its detrimental effects in intra-atrial conduction [ 10 ] as the consequences of atrial remodeling.…”