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. 2024 Jun 14;13(12):3471.
doi: 10.3390/jcm13123471.

Association between Epicardial Adipose Tissue and Atrial Fibrillation in Patients with Transfusion-Dependent β-Thalassemia

Michele Malagù  1 , Elisabetta Tonet  1 , Giovanni Orazio  1 , Filomena Longo  2 , Martina De Raffele  1 , Paolo Sirugo  1 , Andrea Capanni  1 , Stefano Clò  1 , Maria Letizia Berloni  1 , Federico Marchini  1 , Marco Manfrini  3 , Elisa Mari  2 , Olga Soffritti  2 , Martina Culcasi  2 , Cristina Balla  1 , Francesco Vitali  1 , Alberto Cossu  4 , Matteo Bertini  1
Affiliations

Association between Epicardial Adipose Tissue and Atrial Fibrillation in Patients with Transfusion-Dependent β-Thalassemia

Michele Malagù et al. J Clin Med. .

Abstract

Background: Modern treatments for transfusion-dependent β-thalassemia (TDβT) have allowed patients to reach high life expectancy with no iron overload. Despite survival improvement, atrial fibrillation (AF) has emerged as a relevant issue. AF pathophysiology and characteristics in TDβT are different than in the general population. Epicardial adipose tissue (EAT) may play a role but its relationship with AF in patients with TDβT has not been explored. Methods: A monocentric, cross-sectional study, enrolling consecutive patients with TDβT. Epicardial adipose tissue (EAT) was evaluated at magnetic resonance. Characteristics of patients with and without history of AF were investigated. Factors independently associated with AF prevalence were analyzed. Results: A total of 116 patients were enrolled. All patients were treated with regular chelation therapy. The prevalence of AF was 29.3% (34/116). Cardiac T2* and liver iron concentration were no different between patients with and without AF. EAT thickness was significantly higher in patients with AF at left atrium, right atrium and right ventricle (5.0 vs. 4.0 mm, p < 0.01, 4.4 vs. 4.0, p = 0.02 and 5.0 vs. 4.3, p = 0.04). Patients with AF presented with older age, (53 vs. 49 years, p < 0.01), more hypothyroidism (44.1 vs. 20.7%, p = 0.01), pulmonary hypertension (23.5 vs. 2.4% p < 0.01), splenectomy (88.2 vs. 64.6%, p = 0.01), higher right and left atrial volume (61 vs. 40 and 74 vs. 43 mL, both p < 0.01). At multivariable analysis, hypothyroidism, left atrial volume and left atrial EAT were independently associated with AF (odds ratio 9.95, 1.09 and 1.91, respectively). Conclusions: In a contemporary cohort of patients with TDβT, treated with regular chelation therapy, prevalence of AF was unrelated to iron overload. EAT was independently associated with AF.

Keywords: arrhythmia; atrial fibrillation; echocardiography; epicardial fat; hemoglobinopathy; imaging; magnetic resonance; prediction; stroke; thalassemia.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Epicardial adipose tissue evaluation at cardiac magnetic resonance.
Figure 2
Figure 2
Central illustration.
See this image and copyright information in PMC

References

    1. Taher A.T., Musallam K.M., Cappellini M.D. β-Thalassemias. N. Engl. J. Med. 2021;384:727–743. doi: 10.1056/NEJMRA2021838. - DOI - PubMed
    1. Kattamis A., Kwiatkowski J.L., Aydinok Y. Thalassaemia. Lancet. 2022;399:2310–2324. doi: 10.1016/S0140-6736(22)00536-0. - DOI - PubMed
    1. Malagù M., Marchini F., Fiorio A., Sirugo P., Clò S., Mari E., Gamberini M.R., Rapezzi C., Bertini M. Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management. Biology. 2022;11:148. doi: 10.3390/BIOLOGY11010148. - DOI - PMC - PubMed
    1. Forni G.L., Gianesin B., Musallam K.M., Longo F., Rosso R., Lisi R., Gamberini M.R., Pinto V.M., Graziadei G., Vitucci A., et al. Overall and complication-free survival in a large cohort of patients with β-thalassemia major followed over 50 years. Am. J. Hematol. 2023;98:381–387. doi: 10.1002/AJH.26798. - DOI - PubMed
    1. Demircan T., Onder Sivis Z., Tatll Güneş B., Karadeniz C. Evaluation of electrocardiographic markers of cardiac arrhythmic events and their correlation with cardiac iron overload in patients with β-thalassemia major. Cardiol. Young. 2020;30:1666–1671. doi: 10.1017/S1047951120002498. - DOI - PubMed

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