Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan.
J Cardiol. 2012 May;59(3):344-51. doi: 10.1016/j.jjcc.2012.01.006. Epub 2012 Feb 24.
Left ventricular diastolic dysfunction (LVDD) plays an important role in heart failure with normal left ventricular ejection fraction (LVEF). Obesity is one of the major comorbid conditions of LVDD. Pericardial fat (PF) is an ectopic fat depot with possible paracrine or mechanical effects on the coronary circulation and myocardial function.
We measured PF volume on 64 slice computed tomography and analyzed echocardiographic parameters to confirm LVDD in 229 consecutive patients suspected of coronary artery disease with LVEF of more than 50% and no symptomatic heart failure (59% men, 67±12 years). LVDD was defined as the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e') >10.
PF volume correlated significantly with E/e' (r=0.21, p<0.01), left ventricular mass index (r=0.23, p<0.001), and left atrial diameter (r=0.32, p<0.001). The mean PF volume was significantly greater in patients with LVDD (184±61cm(3), n=141) than in those without LVDD (154±58, n=88, p<0.001). Multivariate logistic regression analysis indicated that PF volume correlated significantly with the presence of LVDD (odds ratio: 2.00 per 100cm(3) increase in PF volume, p=0.02) independent of age, gender, abdominal obesity, hypertension, and diabetes.
PF volumes are significantly associated with LVDD, independent of other factors such as hypertension or diabetes. PF may be implicated in the pathogenesis of LVDD in patients with normal LVEF.
左心室舒张功能障碍（LVDD）在射血分数正常的心力衰竭中起重要作用。肥胖是 LVDD 的主要合并症之一。心包脂肪（PF）是异位脂肪库，对冠状动脉循环和心肌功能可能具有旁分泌或机械作用。
我们在 64 层 CT 上测量了 PF 体积，并分析了超声心动图参数，以确认 229 例连续疑似冠心病且 LVEF 大于 50%且无症状心力衰竭的患者（59%为男性，67±12 岁）存在 LVDD。LVDD 的定义为二尖瓣口多普勒早期充盈速度与组织多普勒早期舒张期二尖瓣环速度的比值（E/e'）>10。
PF 体积与 E/e'显著相关（r=0.21，p<0.01）、左心室质量指数（r=0.23，p<0.001）和左心房直径（r=0.32，p<0.001）。LVDD 患者的平均 PF 体积明显大于无 LVDD 患者（184±61cm3，n=141 与 154±58cm3，n=88，p<0.001）。多元逻辑回归分析表明，PF 体积与 LVDD 的存在显著相关（PF 体积每增加 100cm3，比值比：2.00，p=0.02），独立于年龄、性别、腹型肥胖、高血压和糖尿病等因素。
PF 体积与 LVDD 显著相关，独立于高血压或糖尿病等其他因素。PF 可能与射血分数正常的心力衰竭患者 LVDD 的发病机制有关。
