Young Investigators Awards E2117 JACC March 12, 2013 Volume 61, Issue 10 IMPACT OF WEIGHT REDUCTION ON PERICARDIAL FAT AND CARDIAC STRUCTURE IN PATIENTS WITH ATRIAL FIBRILLATION Special Session North, Room 120 Monday, March 11, 2013, 8:00 a.m.-8:15 a.m. Session Title: Young Investigator Awards Competition: Clinical Investigations, Congenital Heart Disease, and Cardiovascular Surgery Abstract Category: Clinical Investigations, Congenital Heart Disease, Cardiac Surgery Presentation Number: 408-4 Authors: Hany S. Abed, Adam Nelson, Darryl Leong, James D. Richardson, Rajiv Mahajan, Anthony Brooks, Walter Abhayaratna, Stephen Worthley, Jonathan Kalman, Gary A. Wittert, Prashanthan Sanders, The University of Adelaide, Adelaide, Australia Objectives: We sought to determine the effect of weight reduction on pericardial fat volume (PF), atrial fibrillation (AF) severity and cardiac structure, in overweight and obese patients. Background: Pericardial fat and obesity have been independently associated with AF. Both factors have been shown to predict atrial enlargement and worse disease outcomes. Methods: We prospectively randomized 70 patients into either a structured weight management program, or a control group receiving lifestyle counseling. Both groups underwent AF Severity Score (AFSS) assessment. We determined the change in AFSS, PF, atrial volumes and myocardial mass (MM) using cardiac MRI at baseline and 12 months follow-up. Results: At 12 months 69 patients completed the study. Weight loss was greater in the intervention group (13.6±5.4kg) compared to controls (5.8±8.7kg), P<0.001. The insulin resistance index (HOMA-IR) decreased from 8.4±3.4 to 4.6±2.8 in the control group and 9.7±4.3 to 3.8±2.5 in the intervention group (P=0.07 for group x time interaction). C-reactive protein (mg/L) decreased from 2.3±1.4 to 1.7±1.1 in the control group and from 2.3±1.8 to 1.3±1.0 in the intervention group (P=0.08 for group x time interaction). There was a greater decline in systolic blood pressure in the intervention group, relative to controls (P<0.001 for group x time interaction). Left atrial (LA) and right atrial (RA) maximal volumes decreased in the intervention group (LA: 8.7±8.8mL, RA: 12.2±9.4mL, decline) compared to a small increase in the control group (LA: 0.2±2.6mL, 0.1±3.6mL), P<0.001 for both atria. There was a significant decline in PF and MM in the intervention group (MM: 14.5±7.0g, PF: 22.0±15.8cm3), compared to an increase in controls (MM: 2.4±6.7g, PF: 4.0±6.9cm3), P<0.001. There was a significant decline in the intervention group AFSS (P<0.001), compared to controls. Of all adiposity measures, PF was the strongest predictor of a favorable improvement in AFSS (P=0.009). Conclusion: Weight reduction is associated with favorable changes in PF volume, atrial size and myocardial mass. Pericardial fat volume is a significant predictor of AF severity. (Trial registration: ACTRN12610000497000.) Downloaded From: http://content.onlinejacc.org/ on 04/24/2015

ACC

Download PDF Report

Upload
hany-abed
View
7
Download
0

Embed Size (px)

Citation preview

Young Investigators Awards

E2117JACC March 12, 2013Volume 61, Issue 10

impacT of weighT reducTion on pericardial faT and cardiac sTrucTure in paTienTs wiTh aTrial fiBrillaTion

Special SessionNorth, Room 120Monday, March 11, 2013, 8:00 a.m.-8:15 a.m.

Session Title: Young Investigator Awards Competition: Clinical Investigations, Congenital Heart Disease, and Cardiovascular SurgeryAbstract Category: Clinical Investigations, Congenital Heart Disease, Cardiac SurgeryPresentation Number: 408-4

Authors: Hany S. Abed, Adam Nelson, Darryl Leong, James D. Richardson, Rajiv Mahajan, Anthony Brooks, Walter Abhayaratna, Stephen Worthley, Jonathan Kalman, Gary A. Wittert, Prashanthan Sanders, The University of Adelaide, Adelaide, Australia

objectives: We sought to determine the effect of weight reduction on pericardial fat volume (PF), atrial fibrillation (AF) severity and cardiac structure, in overweight and obese patients.

Background: Pericardial fat and obesity have been independently associated with AF. Both factors have been shown to predict atrial enlargement and worse disease outcomes.

methods: We prospectively randomized 70 patients into either a structured weight management program, or a control group receiving lifestyle counseling. Both groups underwent AF Severity Score (AFSS) assessment. We determined the change in AFSS, PF, atrial volumes and myocardial mass (MM) using cardiac MRI at baseline and 12 months follow-up.

results: At 12 months 69 patients completed the study. Weight loss was greater in the intervention group (13.6±5.4kg) compared to controls (5.8±8.7kg), P<0.001. The insulin resistance index (HOMA-IR) decreased from 8.4±3.4 to 4.6±2.8 in the control group and 9.7±4.3 to 3.8±2.5 in the intervention group (P=0.07 for group x time interaction). C-reactive protein (mg/L) decreased from 2.3±1.4 to 1.7±1.1 in the control group and from 2.3±1.8 to 1.3±1.0 in the intervention group (P=0.08 for group x time interaction). There was a greater decline in systolic blood pressure in the intervention group, relative to controls (P<0.001 for group x time interaction). Left atrial (LA) and right atrial (RA) maximal volumes decreased in the intervention group (LA: 8.7±8.8mL, RA: 12.2±9.4mL, decline) compared to a small increase in the control group (LA: 0.2±2.6mL, 0.1±3.6mL), P<0.001 for both atria. There was a significant decline in PF and MM in the intervention group (MM: 14.5±7.0g, PF: 22.0±15.8cm3), compared to an increase in controls (MM: 2.4±6.7g, PF: 4.0±6.9cm3), P<0.001. There was a significant decline in the intervention group AFSS (P<0.001), compared to controls. Of all adiposity measures, PF was the strongest predictor of a favorable improvement in AFSS (P=0.009).

conclusion: Weight reduction is associated with favorable changes in PF volume, atrial size and myocardial mass. Pericardial fat volume is a significant predictor of AF severity. (Trial registration: ACTRN12610000497000.)

Downloaded From: http://content.onlinejacc.org/ on 04/24/2015