1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Obesity (Silver Spring). 2010 Dec;18(12):2326-32. doi: 10.1038/oby.2010.65. Epub 2010 Mar 25.
There is increasing evidence that body composition should be considered as a systemic marker of disease severity in congestive heart failure (CHF). Prior studies established bioelectrical impedance analysis (BIA) as an objective indicator of body composition. Epicardial adipose tissue (EAT) quantified by cardiac magnetic resonance (CMR) is the visceral fat around the heart secreting various bioactive molecules. Our purpose was to investigate the association between BIA parameters and EAT assessed by CMR in patients with CHF. BIA and CMR analysis were performed in 41 patients with CHF and in 16 healthy controls. Patients with CHF showed a decreased indexed EAT (22 ± 5 vs. 34 ± 4 g/m(2), P < 0.001) and phase angle (PA) (5.5° vs. 6.4°, P < 0.02) compared to healthy controls. Linear regression analysis showed a significant correlation of CMR indexed EAT with left ventricular ejection fraction (LV-EF) (r = 0.56, P < 0.001), PA (r = 0.31, P = 0.01), total body muscle mass (TBMM) (r = 0.41, P = 0.001), fat-free mass (FFM) (r = 0.30, P = 0.02), and intracellular water (ICW) (0.47, P = 0.0003). Multivariable analysis demonstrated that LV-EF was the only independent determinant of indexed EAT (P < 0.0001). Receiver operating characteristic curve analysis indicated good predictive performance of PA and EAT (area under the curve (AUC) = 0.86 and 0.82, respectively) with respect to cardiac death. After a follow-up period of 5 years, 8/41 (19.5%) patients suffered from cardiac death. Only indexed EAT <22 g/m(2) revealed a statistically significant higher risk of cardiac death (P = 0.02). EAT assessed by CMR correlated with the BIA-derived PA in patients with CHF. EAT and BIA-derived PA might serve as additional prognostic indicators for survival in these patients. However, further clinical studies are needed to elucidate the prognostic relevance of these new findings.
越来越多的证据表明，身体成分应被视为充血性心力衰竭（CHF）疾病严重程度的系统性标志物。先前的研究已经确立了生物电阻抗分析（BIA）作为身体成分的客观指标。心脏磁共振（CMR）量化的心外膜脂肪组织（EAT）是围绕心脏分泌各种生物活性分子的内脏脂肪。我们的目的是研究 CHF 患者 BIA 参数与 CMR 评估的 EAT 之间的相关性。对 41 例 CHF 患者和 16 例健康对照者进行了 BIA 和 CMR 分析。CHF 患者的 EAT 指数（22±5 比 34±4 g/m2，P<0.001）和相位角（PA）（5.5°比 6.4°，P<0.02）均低于健康对照组。线性回归分析显示，CMR 指数 EAT 与左心室射血分数（LV-EF）（r=0.56，P<0.001）、PA（r=0.31，P=0.01）、全身肌肉量（TBMM）（r=0.41，P=0.001）、无脂肪质量（FFM）（r=0.30，P=0.02）和细胞内液（ICW）（r=0.47，P=0.0003）呈显著相关。多变量分析表明，LV-EF 是 EAT 指数的唯一独立决定因素（P<0.0001）。受试者工作特征曲线分析表明，PA 和 EAT 对心脏死亡具有良好的预测性能（曲线下面积（AUC）分别为 0.86 和 0.82）。经过 5 年的随访，41 例患者中有 8 例（19.5%）死于心脏。只有 EAT 指数<22 g/m2 显示出更高的心脏死亡风险（P=0.02）。CMR 评估的 EAT 与 CHF 患者 BIA 衍生的 PA 相关。EAT 和 BIA 衍生的 PA 可能是这些患者生存的额外预后指标。然而，还需要进一步的临床研究来阐明这些新发现的预后相关性。
