Epicardial Fat Thickness and Free Fatty Acid Level are Predictors of Acute Ischemic Stroke with Atrial Fibrillation
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
BACKGROUND: Increased epicardial fat is known to be associated with the presenceand chronicity of atrial fibrillation (AF). Free fatty acids (FFAs) are major componentsof epicardial fat; however, their potential association with AF in ischemic stroke has notbeen investigated. We aimed to assess the performance of echocardiographic epicardial fatthickness (EFT) and plasma FFA level in identifying patients with ischemic stroke and AF. METHODS: We enrolled a total of 214 consecutive patients (mean age, 66.8 ± 12.3 years;39.7% women) diagnosed with acute ischemic stroke between March 2011 and June 2014. Thepatients were divided into two groups: ischemic stroke with AF (n = 35, 16.4%) and ischemicstroke without AF (n = 179, 83.6%). RESULTS: The ischemic stroke with AF group showed significantly higher serum FFA level(1379.7 ± 717.5 vs. 757.8 ± 520.5 uEq/L, p < 0.0001) and EFT (6.5 ± 1.2 vs. 5.3 ± 1.2 mm, p < 0.001)than the group without AF. Multivariable logistic regression analysis demonstrated that age(odds ratio [OR], 1.112), serum FFA level (OR, 1.002), and EFT (OR, 1.740) were independentlyassociated with the ischemic stroke group with AF. EFT and FFA significantly improved thegoodness-of-fit and discriminability of the simple regression model including age as a covariate(log likelihood difference, 21.35; p < 0.001; c-index difference, 17.9%; p < 0.001). CONCLUSIONS: High EFT and serum FFA level were associated with ischemic stroke inpatients with AF. Echocardiographic EFT and serum FFA level can play a significant role inidentifying ischemic stroke with AF.
Abstract
BACKGROUND: Increased epicardial fat is known to be associated with the presenceand chronicity of atrial fibrillation (AF). Free fatty acids (FFAs) are major componentsof epicardial fat; however, their potential association with AF in ischemic stroke has notbeen investigated. We aimed to assess the performance of echocardiographic epicardial fatthickness (EFT) and plasma FFA level in identifying patients with ischemic stroke and AF. METHODS: We enrolled a total of 214 consecutive patients (mean age, 66.8 ± 12.3 years;39.7% women) diagnosed with acute ischemic stroke between March 2011 and June 2014. Thepatients were divided into two groups: ischemic stroke with AF (n = 35, 16.4%) and ischemicstroke without AF (n = 179, 83.6%). RESULTS: The ischemic stroke with AF group showed significantly higher serum FFA level(1379.7 ± 717.5 vs. 757.8 ± 520.5 uEq/L, p < 0.0001) and EFT (6.5 ± 1.2 vs. 5.3 ± 1.2 mm, p < 0.001)than the group without AF. Multivariable logistic regression analysis demonstrated that age(odds ratio [OR], 1.112), serum FFA level (OR, 1.002), and EFT (OR, 1.740) were independentlyassociated with the ischemic stroke group with AF. EFT and FFA significantly improved thegoodness-of-fit and discriminability of the simple regression model including age as a covariate(log likelihood difference, 21.35; p < 0.001; c-index difference, 17.9%; p < 0.001). CONCLUSIONS: High EFT and serum FFA level were associated with ischemic stroke inpatients with AF. Echocardiographic EFT and serum FFA level can play a significant role inidentifying ischemic stroke with AF.
참고문헌 (39)
- 김범준, "Ischemic Stroke Subtype Classification: An Asian Viewpoint", 대한뇌졸중영문학회지, 16(1), pp.8~17 (2014), 대한뇌졸중학회[DOI]
- Sanak D, "Paroxysmal atrial fibrillation in young cryptogenic ischemic stroke: A 3-week ECG Holter monitoring study", Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 159, pp.283~287 (2015)[DOI]
- Mozaffarian D, "Heart disease and stroke statistics--2015 update: a report from the American Heart Association", Circulation, 131, pp.e29~e322 (2015)[DOI]
- Tsang TS, "The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades", J Am Coll Cardiol, 42, pp.93~100 (2003)[DOI]
- Grau AJ, "Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank", Stroke, 32, pp.2559~2566 (2001)[DOI]
- Gage BF, "Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation", JAMA, 285, pp.2864~2870 (2001)[DOI]
- European Heart Rhythm AssociationEuropean Association for Cardio-Thoracic SurgeryCamm AJ, "Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)", Eur Heart J, 31, pp.2369~2429 (2010)[DOI]
- Khawaja O, "Plasma free fatty acids and risk of atrial fibrillation (from the Cardiovascular Health Study)", Am J Cardiol, 110, pp.212~216 (2012)[DOI]
- Djousse L, "Plasma free fatty acids and risk of heart failure: the Cardiovascular Health Study", Circ Heart Fail, 6, pp.964~969 (2013)[DOI]
- Al Chekakie MO, "Pericardial fat is independently associated with human atrial fibrillation", J Am Coll Cardiol, 56, pp.784~788 (2010)[DOI]
- Ouchi N., "Obesity: Progress in diagnosis and treatment; Topics, IV. Recent topics; 3. Obesity and new secretory factors; 2) Sfrp 5 acts as a novel adipocytokine that affects metabolic function", Nihon Naika Gakkai Zasshi, 100, pp.1002~1007 (2011)[DOI]
- Chhabra L, "Role of epicardial fat in atrial fibrillation after coronary artery bypass surgery", Am J Cardiol, 113, pp.2090~ (2014)[DOI]
- Hendrickson SC, "Free fatty acid metabolism during myocardial ischemia and reperfusion", Mol Cell Biochem, 166, pp.85~94 (1997)[DOI]
- Mazzali G, "Heart fat infiltration in subjects with and without coronary artery disease", J Clin Endocrinol Metab, 100, pp.3364~3371 (2015)[DOI]
- Pantanowitz L, "Fat infiltration in the heart", Heart, 85, pp.253~ (2001)[DOI]
- Lin YK, "Adipocytes modulate the electrophysiology of atrial myocytes: implications in obesity-induced atrial fibrillation", Basic Res Cardiol, 107, pp.293~ (2012)[DOI]
- Abed HS, "Obesity results in progressive atrial structural and electrical remodeling: implications for atrial fibrillation", Heart Rhythm, 10, pp.90~100 (2013)[DOI]
- Hirata Y, "Clinical utility of measuring epicardial adipose tissue thickness with echocardiography using a high-frequency linear probe in patients with coronary artery disease", J Am Soc Echocardiogr, 28, pp.1240~1246 (2015)[DOI]
- Tok D, "Impaired coronary flow reserve is associated with increased echocardiographic epicardial fat thickness in metabolic syndrome patients", Coron Artery Dis, 24, pp.191~195 (2013)[DOI]
- Kim BJ, "Echocardiographic epicardial fat thickness is associated with arterial stiffness", Int J Cardiol, 167, pp.2234~2238 (2013)[DOI]
- Kim BJ, "Echocardiographic epicardial fat thickness is associated with coronary artery calcification - results from the CAESAR study", Circ J, 79, pp.818~824 (2015)[DOI]
- Sengul C, "Echocardiographic epicardial fat thickness is associated with carotid intima-media thickness in patients with metabolic syndrome", Echocardiography, 28, pp.853~858 (2011)[DOI]
- Stojanovska J, "Increased epicardial fat is independently associated with the presence and chronicity of atrial fibrillation and radiofrequency ablation outcome", Eur Radiol, 25, pp.2298~2309 (2015)[DOI]
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment", Stroke, 24, pp.35~41 (1993)[DOI]
- 오미선, "Validity and Reliability of a Korean Version of the National Institutes of Health Stroke Scale", Journal of Clinical Neurology, 8(3), pp.177~183 (2012), 대한신경과학회[DOI]
- Bonita R, "Recovery of motor function after stroke", Stroke, 19, pp.1497~1500 (1988)[DOI]
- Levy D, "Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study", Am J Cardiol, 59, pp.956~960 (1987)[DOI]
- Shim IK, "Impact of Gender on the Association of Epicardial Fat Thickness, Obesity, and Circadian Blood Pressure Pattern in Hypertensive Patients", J Diabetes Res, 2015, pp.924539~ (2015)
- Harrell FE Jr, "Evaluating the yield of medical tests", JAMA, 247, pp.2543~2546 (1982)[DOI]
- DeLong ER, "Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach", Biometrics, 44, pp.837~845 (1988)[DOI]
- Acet H, "New inflammatory predictors for non-valvular atrial fibrillation: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio", Int J Cardiovasc Imaging, 30, pp.81~89 (2014)
- Soeki T, "Role of epicardial adipose tissue in atrial fibrillation", Circ J, 76, pp.2738~2739 (2012)[DOI]
- Spence JD, "Free fatty acids and stroke from atrial fibrillation", Can J Neurol Sci, 38, pp.803~ (2011)[DOI]
- Jickling GC, "Free fatty acids to predict recurrent ischemic stroke", Neurology, 82, pp.1110~1111 (2014)[DOI]
- Seo WK, "Elevated free fatty acid is associated with cardioembolic stroke subtype", Can J Neurol Sci, 38, pp.874~879 (2011)[DOI]
- Choi JY, "Free fatty acid as an outcome predictor of atrial fibrillation-associated stroke", Ann Neurol, 79, pp.317~325 (2016)[DOI]
- Koutsari C, "Plasma free fatty acid storage in subcutaneous and visceral adipose tissue in postabsorptive women", Diabetes, 57, pp.1186~1194 (2008)[DOI]
- O'Connell RP, "Free fatty acid effects on the atrial myocardium: membrane ionic currents are remodeled by the disruption of T-tubular architecture", PLoS One, 10, pp.e0133052~ (2015)[DOI]
- Petrovicova A, "Detection of occult paroxysmal atrial fibrilation by implantable long-term electrocardiographic monitoring in cryptogenic stroke and transient ischemic attack population: a study protocol for prospective matched cohort study", BMC Cardiovasc Disord, 15, pp.160~ (2015)[DOI]