A Study on the Remodeling of the Left Atrial Appendage and Epicardial Adipose Tissue in Patients with Atrial Fibrillation and Diabetes Based on CT Imaging

Background: Diabetes is common among patients with atrial fibrillation (AF) and the number of affected individuals is increasing. One of the most severe complications of AF is thromboembolic events. The left atrial appendage (LAA), a thumb-sized accessory chamber directly connected to the left atrium, is the most common site for thrombus formation. In addition, epicardial adipose tissue (EAT), a special type of visceral tissue, has an intrinsic link with the occurrence of AF through changes in its volume and density. Objective: The purpose of this study is to use dual-source CT imaging technology to compare and analyze the differences in the remodeling of the left atrial appendage and epicardial adipose tissue between patients with atrial fibrillation who have diabetes and those who do not, in order to provide more effective prevention and management strategies for patients with atrial fibrillation. Methods: This study retrospectively analyzed the clinical data of 169 patients diagnosed with Hospital A from June 2020 to April 2021. The 169 patients were divided into two subgroups: 84 patients with diabetes (diabetes group) and 85 patients without diabetes (non-diabetes group). The patients underwent dual-source CT scanning to measure the length, width, depth, and area of the left atrial appendage orifice, as well as the volume and mean density of epicardial adipose tissue. Results: The study results showed that there were significant differences between patients with atrial fibrillation and diabetes and those without diabetes in terms of hypertension, cerebral infarction, coronary heart disease, systolic blood pressure, and CHA2DS2-VAS score (P<0.05). Imaging analysis indicated that the length, width, depth, and orifice area of the left atrial appendage were significantly larger in the diabetes group than in the non-diabetes group (P<0.05), and the incidence of thrombus in the left atrial appendage was higher in the diabetes group. Although there was no significant difference in epicardial adipose tissue volume between the two groups, the mean density of EAT was higher in the diabetes group (P<0.05). Logistic regression analysis identified diabetes, CHA2DS2-VAS score, length of the left atrial appendage, width of the left atrial appendage, orifice area of the left atrial appendage, and EAT volume as risk factors for cerebral infarction (P<0.05). Among them, CHA2DS2-VAS score, length of the left atrial appendage, width of the left atrial appendage, and EAT volume had a significant positive impact on cerebral infarction, while diabetes and orifice area of the left atrial appendage had a significant negative impact. Receiver operating characteristic (ROC) curve analysis showed that CHA2DS2-VAS score, length of the left atrial appendage, and EAT volume had high diagnostic value for cerebral infarction in patients with atrial fibrillation. Conclusion: Patients with atrial fibrillation who have diabetes and those who do not have significant differences in clinical characteristics, left atrial appendage structure, and epicardial adipose tissue-related indicators. These differences are associated with the risk of thromboembolic events such as cerebral infarction.