Post-Operative Atrial Fibrillation: Novel Predictive Value of CT-Derived Adipose Tissue Density in Minimally Invasive...

Area of Science:

• Cardiology
• Radiology
• Metabolic Surgery

Background:

• Postoperative atrial fibrillation (POAF) is a common complication after minimally invasive thoracoscopic mitral valve surgery (MITMVS).
• Existing risk prediction models often fail to identify metabolic factors contributing to POAF.
• Computed tomography (CT)-derived body composition may offer insights into metabolic status and arrhythmogenesis.

Purpose of the Study:

• To evaluate if CT-derived body composition parameters can predict POAF risk in patients undergoing MITMVS.
• To explore the association between tissue density (visceral adipose tissue, subcutaneous adipose tissue, intramuscular adipose tissue) and POAF development.

Main Methods:

• Retrospective analysis of 104 MITMVS patients (2014-2023).
• Preoperative CT scans were used to quantify skeletal muscle index, muscle density, and visceral/subcutaneous adipose tissue.
• Patients were categorized based on prior atrial fibrillation (AF) history.

Main Results:

• Increased visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) density were associated with higher odds of POAF.
• The highest VAT density quartile showed a 5.5-fold increased POAF risk compared to the lowest.
• Intramuscular adipose tissue (IMAT) density's association with POAF varied based on prior AF history.

Conclusions:

• CT-derived tissue quality parameters, especially VAT density, are strongly associated with POAF risk after MITMVS.
• Preoperative CT-based metabolic assessment can serve as a valuable tool for perioperative risk stratification.
• This approach offers a non-invasive method for risk assessment without additional testing burden.