Department of Endocrinology, Metabolic Diseases and Nutrition, CHU Nord, Marseille, France.
Int J Obes (Lond). 2012 Mar;36(3):422-30. doi: 10.1038/ijo.2011.117. Epub 2011 Jul 5.
To assess epicardial fat volume (EFV), myocardial TG content (MTGC) and metabolic profile in severely obese patients, and to determine whether ectopic fat depots are linked to metabolic disorders or myocardial function.
Sixty-three subjects with normal LV function and no coronary artery disease, including 33 lean (BMI: 21.4 ± 2.0 kg m(-2)) and 30 obese (BMI: 41.8 ± 6 kg m(-2)) patients, underwent 3-T cardiovascular MRI, and anthropometric, biological and visceral abdominal fat (VAT) assessments. EFV was measured by short-axis slice imaging and myocardial (intra-myocellular) TG content was measured by proton magnetic resonance spectroscopy.
EFV and MTGC were positively correlated (r=0.52, P<0.0001), and were both strongly correlated with age, BMI, waist circumference and VAT, but not with severity of obesity. EFV and MTGC were significantly higher in obese patients than in lean controls (141 ± 18 versus 79 ± 7 ml, P=0.0001; 1.0 ± 0.1 versus 0.6 ± 0.1%, P=0.01, respectively), but some differences were found between the two cardiac depots: EFV was higher in diabetic obese subjects as compared with that in non-diabetic obese subjects (213 ± 34 versus 141 ± 18 ml, P=0.03), and was correlated with parameters of glucose tolerance (fasting plasma glucose, insulin and HOMA-IR), whereas MTGC was not. EFV and MTGC were both associated with parameters of lipid profile or inflammation (TGs, CRP). Remarkably, this was VAT-dependent, as only VAT remained independently associated with metabolic parameters (P<0.01). Concerning myocardial function, MTGC was the only parameter independently associated with stroke volume (β=-0.38, P=0.01), suggesting an impact of cardiac steatosis in cardiac function.
These data show that VAT dominates the relationship between EFV, MTGC and metabolic measures, and uncover specific partitioning of cardiac ectopic lipid deposition.
评估严重肥胖患者的心外膜脂肪体积（EFV）、心肌甘油三酯含量（MTGC）和代谢特征，并确定异位脂肪沉积与代谢紊乱或心肌功能之间是否存在关联。
63 名左心室功能正常且无冠状动脉疾病的受试者，包括 33 名瘦（BMI：21.4±2.0kg/m²）和 30 名肥胖（BMI：41.8±6kg/m²）患者，接受了 3-T 心血管 MRI 检查，并进行了人体测量、生物学和内脏脂肪（VAT）评估。EFV 通过短轴切片成像测量，心肌（细胞内）甘油三酯含量通过质子磁共振波谱测量。
EFV 和 MTGC 呈正相关（r=0.52，P<0.0001），且均与年龄、BMI、腰围和 VAT 呈强相关，但与肥胖严重程度无关。与瘦对照组相比，肥胖患者的 EFV 和 MTGC 均显著升高（141±18 与 79±7ml，P=0.0001；1.0±0.1 与 0.6±0.1%，P=0.01），但两个心脏部位之间存在一些差异：与非糖尿病肥胖患者相比，糖尿病肥胖患者的 EFV 更高（213±34 与 141±18ml，P=0.03），且与葡萄糖耐量参数（空腹血糖、胰岛素和 HOMA-IR）相关，而 MTGC 则不然。EFV 和 MTGC 均与血脂参数或炎症（TGs、CRP）相关。值得注意的是，这是与 VAT 相关的，因为只有 VAT 仍然与代谢参数独立相关（P<0.01）。就心肌功能而言，MTGC 是唯一与每搏输出量独立相关的参数（β=-0.38，P=0.01），提示心脏脂肪变性对心脏功能有影响。
这些数据表明，VAT 主导着 EFV、MTGC 和代谢指标之间的关系，并揭示了心脏异位脂质沉积的特定分布。
