Baldasseroni Samuele, Pratesi Alessandra, Orso Francesco, Di Serio Claudia, Foschini Alice, Marella Andrea Giosafat, Bartoli Nadia, Di Bari Mauro, Fumagalli Stefano, Marchionni Niccolò, Tarantini Francesca
Monaldi Arch Chest Dis. 2013 Dec;80(4):170-6. doi: 10.4081/monaldi.2013.5233.
Epicardial adipose tissue (EAT) is a visceral fat that fulfills two important functions: lipid-storage and secretion of adipokines with pro-inflammatory and pro-atherogenic properties. It has been suggested that EAT may affect the pathogenesis of atherosclerosis and the clinical course of coronary artery disease (CAD). In patients with obesity, diabetes and metabolic syndrome, the epicardial adipose tissue is enlarged. Little is known about the role of EAT in left ventricular dysfunction. Aim of this study was to evaluate the ability of insulin resistance to predict EAT thickness in patients with significant CAD and systolic dysfunction.
We enrolled 114 subjects diagnosed with CAD by angiography. The majority underwent revascularization after an acute coronary syndrome. Patients were considered affected by significant left ventricular dysfunction when EF was < or = 40%. Three indexes of insulin resistance, the HOMA IR index, the insulin sensitivity QUICKI index, and the novel adiponectin/resistin index (ADIPO-IRAR) were calculated and correlated to EAT thickness. Epicardial fat was measured by echocardiography according to standardized methods.
Subjects with diabetes and with a history of hypercholesterolemia had thicker EAT compared to controls. Potassium levels and all three indexes of insulin resistance were the best independent predictors of EAT in the study population as a whole and in the subset of patients with left ventricular dysfunction. In the latter group the novel ADIPO-IRAR index displayed the strongest predictivity.
Insulin resistance is an independent predictor of EAT thickness in patients affected by CAD, also in the presence of significant left ventricular dysfunction.
心外膜脂肪组织（EAT）是一种内脏脂肪，具有两项重要功能：脂质储存以及分泌具有促炎和促动脉粥样硬化特性的脂肪因子。有人提出，EAT可能会影响动脉粥样硬化的发病机制以及冠状动脉疾病（CAD）的临床病程。在肥胖、糖尿病和代谢综合征患者中，心外膜脂肪组织会增大。关于EAT在左心室功能障碍中的作用，目前所知甚少。本研究的目的是评估胰岛素抵抗预测重度CAD和收缩功能障碍患者EAT厚度的能力。
我们纳入了114名经血管造影诊断为CAD的受试者。大多数人在急性冠状动脉综合征后接受了血运重建。当射血分数（EF）≤40%时，患者被认为患有重度左心室功能障碍。计算了胰岛素抵抗的三个指标，即稳态模型评估胰岛素抵抗（HOMA IR）指数、胰岛素敏感性定量胰岛素敏感性检查指数（QUICKI）以及新的脂联素/抵抗素指数（ADIPO - IRAR），并将其与EAT厚度进行关联分析。根据标准化方法通过超声心动图测量心外膜脂肪。
与对照组相比，患有糖尿病和有高胆固醇血症病史的受试者EAT更厚。钾水平和所有三个胰岛素抵抗指标是整个研究人群以及左心室功能障碍患者亚组中EAT的最佳独立预测指标。在后一组中，新的ADIPO - IRAR指数显示出最强的预测性。
胰岛素抵抗是CAD患者EAT厚度的独立预测指标，在存在重度左心室功能障碍的情况下也是如此。
