Assessing left atrial intramyocardial fat infiltration from computerized tomography angiography in patients with atrial fibrillation

Background: Epicardial adipose tissue might promote atrial fibrillation (AF) in several ways, including infiltrating the underlying atrial myocardium. However, the role of this potential mechanism has been poorly investigated. Aim: Aim of the present study is to evaluate the presence of left atrial (LA) infiltrated adipose tissue (inFAT) by analyzing multidetector computer tomography (MDCT)-derived three-dimensional (3D) fat infiltration maps and to compare the extent of LA inFAT between patients without AF history, with paroxysmal, and with persistent AF. Methods: Sixty consecutive patients with AF diagnosis (30 persistent and 30 paroxysmal) were enrolled and compared with 20 age-matched control; MDCT-derived images were post-processed to obtain 3D LA inFAT maps for all patients. Volume [ml] and mean signal intensities [HU] of inFAT (HU -194; -5), dense inFAT (HU -194; -50) and fat-myocardial admixture (HU -50; -5) were automatically computed by the software. Results: inFAT volume was significantly different across the three groups (p = 0.009), with post-hoc pairwise comparisons showing significant increase in inFAT volume in persistent AF compared to controls (p = 0.006). Dense inFAT retained a significant difference also after correcting for body mass index (p = 0.028). In addition, more negative inFAT radiodensity values were found in AF patients. Regional distribution analysis showed a significantly higher regional distribution of LA inFAT at left and right superior pulmonary vein antra in AF patients. Conclusions: Persistent forms of AF are associated to greater degree of LA intramyocardial adipose infiltration, independently of BMI. Compared to controls, AF patients present higher LA inFAT volume at left and right superior pulmonary vein antra.