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Updated: Aug 7, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Epicardial Fat Tissue Volume Within 1 mm of the Left Atrium Combined With Left Atrial Appendage Volume is Associated
Enyuan Zhang1,2, Xiaoyan Wu3, Fengmin Lu2
1Tianjin Medical University, Tianjin, China, tijmu.edu.cn.
Insights
Epicardial fat tissue (EFT) volume near the left atrium improves prediction of left atrial appendage thrombus (LAAT) in atrial fibrillation (AF) patients. A new nomogram using EFT, LA volume, and CHA2DS2-VA score enhances stroke risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Radiology
Background:
- Accurate prediction of left atrial appendage thrombus (LAAT) is crucial for stroke prevention in nonvalvular atrial fibrillation (AF) patients.
- Conventional risk factors do not fully capture the risk of LAAT.
- Epicardial fat tissue (EFT) metrics may offer incremental value in predicting LAAT.
Purpose of the Study:
- To investigate the incremental value of EFT metrics from cardiac computed tomography angiography (CCTA) for predicting LAAT.
- To develop and validate a nomogram for enhanced risk stratification of thrombotic and prethrombotic states in AF patients.
Main Methods:
- Retrospective study of 287 AF patients undergoing CCTA.
- Measurement of left atrial appendage volume (LAAV) and EFT volume within 1mm of the left atrium (EFT1).
- Multivariate logistic regression and nomogram development, validated by AUC, calibration, and decision curve analysis.
Main Results:
- Patients with LAAT had significantly larger LAAV and EFT1 volumes compared to controls.
- EFT1 (OR=1.57), LAAV (OR=1.56), and CHA2DS2-VA score (OR=1.34) were independent predictors of LAAT.
- The nomogram showed excellent discrimination for LAAT (AUC=0.851) and thrombus/SEC (AUC=0.819).
Conclusions:
- EFT volume immediately adjacent to the left atrium (EFT1) is strongly associated with LAAT.
- A novel nomogram integrating EFT1, LAAV, and CHA2DS2-VA score enhances risk stratification for thrombotic and prethrombotic states in AF patients.
Background:
Accurate prediction of left atrial appendage thrombus (LAAT) is critical for stroke prevention in patients with nonvalvular atrial fibrillation (AF). We investigated the incremental value of epicardial fat tissue (EFT) metrics derived from cardiac computed tomography angiography (CCTA) beyond conventional risk factors.
Methods:
In this retrospective study of 287 AF patients prior to ablation, CCTA was used to measure left atrial appendage volume (LAAV) and EFT volume within 1 mm of the left atrium (EFT1). Multivariate logistic regression analysis identified predictors of LAAT or prethrombotic state (thrombus/spontaneous echo contrast), which were incorporated into a nomogram. Model performance was evaluated using the area under the curve (AUC), calibration plots, and decision curve analysis.
Results:
The thrombus group exhibited significantly larger LAAV (15.07 ± 2.7 mL vs. 11.94 ± 2.55 mL, p < 0.001) and EFT1 volume (6.39 ± 1.38 mL vs. 5.36 ± 1.47 mL, p < 0.001) compared to the normal/SEC group. Multivariate analysis identified EFT1 (odds ratio [OR] = 1.57 per mL), LAAV (OR = 1.56 per mL), and the CHA2DS2-VA score (OR = 1.34 per point) as independent predictors. The resulting nomogram demonstrated excellent discrimination for LAAT (AUC = 0.851) and for thrombus/SEC (AUC = 0.819), with good calibration and clinical utility.
Conclusion:
EFT1, the EFT volume immediately adjacent to the left atrium, is strongly associated with LAAT. The novel nomogram integrating EFT1, LAAV, and the CHA2DS2-VA score provides enhanced risk stratification for thrombotic and prethrombotic states in patients with AF.
