J Cardiovasc Imaging.  2018 Jun;26(2):65-74. 10.4250/jcvi.2018.26.e1.

Epicardial Fat Thickness and Free Fatty Acid Level are Predictors of Acute Ischemic Stroke with Atrial Fibrillation

• Cho KI
• Kim BJ
• Cho SH
• Lee JH
• Kim MK
• Yoo BG

• KMID: 2415456
• DOI: http://doi.org/10.4250/jcvi.2018.26.e1

Abstract

BACKGROUND
Increased epicardial fat is known to be associated with the presence and chronicity of atrial fibrillation (AF). Free fatty acids (FFAs) are major components of epicardial fat; however, their potential association with AF in ischemic stroke has not been investigated. We aimed to assess the performance of echocardiographic epicardial fat thickness (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. The patients were divided into two groups: ischemic stroke with AF (n = 35, 16.4%) and ischemic stroke 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 independently associated with the ischemic stroke group with AF. EFT and FFA significantly improved the goodness-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 in patients with AF. Echocardiographic EFT and serum FFA level can play a significant role in identifying ischemic stroke with AF.

Keyword

Stroke; Epicardial fat thickness; Free fatty acids; Atrial fibrillation

MeSH Terms

Atrial Fibrillation*
Echocardiography
Fatty Acids, Nonesterified
Humans
Logistic Models
Plasma
Stroke*
Fatty Acids, Nonesterified

Figure

• 

  Figure 1 Comparison of four different logistic regression models of the incremental effect of EFT and FFA on ischemic stroke with AF. Comparison of these models showed that EFT and FFA significantly improved the goodness-of-fit and discriminability of Model 1 (log likelihood difference, 21.35; p < 0.001; c-index difference, 17.9%; p < 0.001). AF: atrial fibrillation, AUC: area under curve, EFT: epicardial fat thickness, FFA: free fatty acid.

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