Potential of Epicardial Adipose Tissue Quantification in Predicting Atrial Thrombus in Patients With Atrial...

Atrial fibrillation (AF) can increase the risk of stroke by five-fold; strokes associated with AF are more likely to lead to death or severe disability in patients. Thus, preventing the formation of thrombosis is of vital importance in the treatment of patients with AF. Epicardial adipose tissue (EAT) is a risk factor for AF and is closely associated with many AF-related complications. However, to our knowledge, no in-depth studies on the relationship between the incidence of thrombosis in AF patients and EAT have been conducted. Therefore, it is of great clinical significance to explore the potential of EAT quantification in predicting intra-atrial thrombosis in patients with AF.

This is a case-control study; patients with AF who underwent coronary computed tomography angiography (CCTA) were included. These patients were divided into the thrombus group and the non-thrombus group according to the results of transesophageal echocardiography (TEE). The volume of EAT, the mean density of EAT, and the ratio of EAT volume to the whole heart volume were measured by CCTA, and the data of the two groups were compared. Meanwhile, the diagnostic efficiency of using these parameters was analyzed.

A total of 308 patients with AF who underwent both TEE and CCTA were enrolled in this study. After a 1:1 propensity score matching (PSM) analysis based on age and sex, a total of 76 patients were finally included. Compared with the patients in the non-thrombus group, those in the thrombus group had a larger volume of EAT (132.38 ± 45.25 cm³ vs. 95.51 ± 25.38 cm³; p < 0.001) and a higher ratio of EAT volume to the whole heart volume (0.13 ± 0.05 vs. 0.10 ± 0.03; p < 0.05). However, there was no difference in the mean density of EAT between the two groups. The volume of EAT was identified as an independent risk factor (odds ratio = 1.042; p = 0.003). Moreover, the receiver operating characteristic (ROC) analysis presented the EAT volume as a potential diagnostic value in predicting intra-atrial thrombus in AF patients, with an area under the curve (AUC) of 0.755.

The EAT volume may be a potential biomarker for predicting intra-atrial thrombosis in patients with AF; however, further validation is required to confirm the diagnostic value.