Skip to content


  • Poster presentation
  • Open Access

Epicardial adipose tissue volume by cardiac magnetic resonance imaging predicts abnormal myocardial relaxation in patients with atrial fibrillation

  • 2,
  • 1,
  • 2,
  • 2,
  • 3,
  • 2 and
  • 2
Journal of Cardiovascular Magnetic Resonance201517 (Suppl 1) :P352

  • Published:


  • Cardiac Magnetic Resonance
  • Filling Pressure
  • Epicardial Adipose Tissue
  • Eventual Heart Failure
  • Epicardial Adipose Tissue Volume


Inflammation may be a key trigger in the accumulation of extracellular matrix that leads to fibrosis, abnormal myocardial relaxation, diastolic dysfunction and eventual heart failure with a preserved ejection fraction (HFpEF). Epicardial adipose tissue (EAT) is a metabolically active organ releasing various adipokines and inflammatory mediators which may promote fibrosis in adjacent myocardium altering the structural properties of the ventricle leading to abnormal diastology. The aim of this study was to assess the relationship of EAT volume using cardiac magnetic resonance imaging (CMR) and parameters of diastolic dysfunction as assessed by 2D-transthoracic echocardiography (TTE) in patients with atrial fibrillation (AF).


We conducted a retrospective study of 20 patients with AF who underwent CMR and TTE prior to ablation between 11/1/2010 and 10/17/2013 (Table 1). CMR Images were acquired on a 3T scanner (Siemens Trio) by steady state free precession (SSFP) using a standard short axis stack through the atria and ventricles. Epicardial adipose tissue quantification was peformed using a short axis stack through the atria and ventricles at end-diastole. For each short axis slice, the myo-epicardial and pericardial borders were manually traced and EAT volumes were calculated by summation of the area x thickness in each slice using CMR42 software (Circle CVI, Calgary, Alberta, Canada). For each TTE, pulsed wave Doppler of mitral inflow from the apical four chamber view and tissue Doppler of mitral annular excursion was performed. The following diastolic parameters were recorded for analysis: myocardial relaxation index (e' septal) and left ventricular filling pressures (E/e').
Table 1

Baseline patient characteristics


Patients (n=20)

Age (years)



12 (60)

Diabetes mellitus

1 (5)


10 (50)

Obstructive sleep apnea

1 (5)

Paroxysmal atrial fibrillation

15 (75)

Body mass index (kg/m2)

28.6 +/- 5

Body surface area (m2)

2.06 +/- 0.23

TTE: Myocardial relaxation index (septal e')

8.14 +/- 2.29

TTE: Left ventricular filling pressures (E/e')

10.75 +/- 3.13

CMR: Left atrial volume (mL)

104.5 +/-36.64

CMR: Left atrial volume index (mL/m2)

51.98 +/- 14.71

CMR: Epicardial adipose tissue volume (mL)

125.7 +/- 56.7

CMR:Left ventricular ejection fraction

60.93 +/- 4.81

Data are expressed as means +/- standard deviation or number (%) of patients

TTE: transthoracic echocardiography; CMR: cardiac magnetic resonance imaging


Patients with elevated filling pressures (E/e' >15) had significantly higher EAT compared to those with normal filling pressures (E/e' <15) (164ml±118 vs 114ml±54, p<0.001). By univariate analysis, EAT volume had a significant inverse correlation with e' sep (r =-0.48, p=0.02), but not hypertension (r=0.25, p=0.09), or E/e' (r = 0.22, p=0.21). EAT volume remained the only significant predictor of abnormal myocardial relaxation in a multivariate linear regression model incorporating age, BMI, LA volume, hypertension and coronary artery disease (p = 0.04).


EAT volume quantified by CMR is independently associated with abnormal myocardial relaxation in patients with AF. EAT may serve as a novel therapeutic target to preserve diastolic function.



Authors’ Affiliations

Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
Department of Biological Sciences, East-West University, Chicago, IL, USA


© Fernando et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.