The Association of Epicardial Adipose Tissue Volume and Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy: As Assessed by Cardiac MR

Background Epicardial adipose tissue (EAT) is a metabolically active visceral fat linked to cardiovascular disease. Prior studies demonstrated the predictive value of EAT volume (EATV) in atrial fibrillation (AF) among hypertrophic obstructive cardiomyopathy patients. Purpose To investigate the association between EATV and AF in hypertrophic cardiomyopathy (HCM). Study Type Retrospective. Population Two hundred and twenty‐four HCM patients (including 79 patients with AF and 145 patients without AF, 154 men) and 80 healthy controls (54 men). Field Strength/Sequence 3.0 T scanner; balanced steady‐state free precession (SSFP) cine sequence, gradient echo. Assessment EAT thickness was assessed in the 4‐chamber and basal short‐axis planes. EAT volume was calculated by outlining the epicardial border and visceral pericardium layer on short‐axis cine images. Statistical Tests Shapiro–Wilk test, Student's t test or the Mann–Whitney U test, chi‐square test or Fisher's exact test, Multivariate linear regression analyses, Multivariable binary logistic regression analysis. Intraclass correlation coefficient. Significance was determined at P < 0.05. Results EATV and EAT volume index (EATVI) were significantly greater in HCM patients with AF than those without AF (126.6 ± 25.9 mL vs. 90.5 ± 24.5 mL, and 73.0 ± 15.9 mL/m 2 vs. 51.3 ± 13.4 mL/m 2 ). EATVI was associated with AF in multivariable linear regression analysis among HCM patients ( β = 0.62). Multivariable logistic regression analysis revealed that compared to other indicators, the area under curve (AUC) of EATVI was 0.86 (cut‐off, 53.9 mL/m 2 , 95% CI, 0.80–0.89), provided a better performance, with the sensitivity of 96.2% and specificity of 58.6%. The combined model exhibited superior association with AF presence compared to the clinical model (AUC 0.96 vs. 0.76) and the imaging model (AUC 0.96 vs. 0.93). Data Conclusion EATVI was associated with AF. EATVI was significantly correlated with incident AF, and provided a better performance in HCM patients compared to other indicators. Evidence Level 3 Technical Efficacy Stage 2