心包脂肪堆积而非内脏脂肪堆积是腹膜透析患者左心室舒张功能障碍的独立危险因素。

Accumulation of epicardial fat rather than visceral fat is an independent risk factor for left ventricular diastolic dysfunction in patients undergoing peritoneal dialysis.

机构信息

Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital No, 7, Chung-Shan South Road Taipei 100, Taipei, Taiwan.

出版信息

Cardiovasc Diabetol. 2013 Aug 30;12:127. doi: 10.1186/1475-2840-12-127.

DOI:10.1186/1475-2840-12-127

PMID:24001037

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3766214/

Abstract

BACKGROUND

Symptoms of heart failure with preserved left ventricular systolic function are common among patients undergoing peritoneal dialysis (PD). Epicardial fat (EpF) is an ectopic fat depot with possible paracrine or mechanical effects on myocardial function. The aim of our current study is to assess the association between EpF and Left ventricular diastolic dysfunction (LVDD) in patients undergoing PD and to clarify the relationships among EpF, inflammation, and LVDD in this population.

METHODS

This was a cross-sectional study of 149 patients with preserved left ventricular systolic function who were undergoing PD. LVDD was diagnosed (according to the European Society of Cardiology guidelines) and EpF thickness measured by echocardiography. The patients without LVDD were used as controls. The serum inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) was measured. The location and amount of adipose tissue were assessed by computed tomography (CT) at the level of the fourth lumbar vertebra.

RESULTS

Subjects with LVDD had higher levels of hsCRP, more visceral and peritoneal fat, and thicker EpF (all p < 0.001) than controls. Visceral adipose tissue, hsCRP, and EpF all correlated significantly (p < 0.05) with LVDD. Multivariate regression analysis rendered the relationship between visceral adipose tissue and LVDD insignificant, whereas EpF was the most powerful determinant of LVDD (odds ratio = 2.41, 95% confidence interval = 1.43-4.08, p < 0.01). EpF thickness also correlated significantly with the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e'; r = 0.27, p < 0.01).

CONCLUSION

EpF thickness is significantly independently associated with LVDD in patients undergoing PD and may be involved in its pathogenesis.

摘要

背景

左心室射血分数保留的心力衰竭症状在接受腹膜透析（PD）的患者中很常见。心外膜脂肪（EpF）是一种异位脂肪库，可能对心肌功能具有旁分泌或机械作用。我们目前的研究旨在评估 EpF 与接受 PD 的患者的左心室舒张功能障碍（LVDD）之间的关联，并阐明在该人群中 EpF、炎症和 LVDD 之间的关系。

方法

这是一项横断面研究，纳入了 149 名接受 PD 的左心室射血分数保留的患者。通过超声心动图诊断 LVDD，并测量 EpF 厚度。将没有 LVDD 的患者作为对照组。测量血清炎症生物标志物高敏 C 反应蛋白（hsCRP）。使用 CT 在第四腰椎水平评估脂肪组织的位置和数量。

结果

与对照组相比，LVDD 患者的 hsCRP 水平更高，内脏和腹膜脂肪更多，EpF 更厚（均 p < 0.001）。内脏脂肪组织、hsCRP 和 EpF 均与 LVDD 显著相关（p < 0.05）。多元回归分析显示，内脏脂肪组织与 LVDD 的关系不再显著，而 EpF 是 LVDD 的最强决定因素（比值比=2.41，95%置信区间=1.43-4.08，p < 0.01）。EpF 厚度与二尖瓣瓣环组织多普勒早期舒张运动速度与经二尖瓣多普勒早期充盈速度的比值（E/e'）也显著相关（r=0.27，p < 0.01）。