Nakanishi Koki, Fukuda Shota, Tanaka Atsushi, Otsuka Kenichiro, Jissho Satoshi, Taguchi Haruyuki, Yoshikawa Junichi, Shimada Kenei
Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Medicine, Osaka Ekisaikai Hospital, Osaka, Japan.
Atherosclerosis. 2014 Nov;237(1):353-60. doi: 10.1016/j.atherosclerosis.2014.09.015. Epub 2014 Sep 28.
Objective. Epicardial adipose tissue (EAT) is recognized as a novel risk factor for coronary artery disease (CAD), and its contribution is thought to be stronger in non-obese patients than in obese patients. However, the prognostic impact of the progression of EAT accumulation after comprehensive management for atherosclerotic risk factors remains unclear. This study aimed to investigate whether an increase of the EAT volume during follow-up predicts future acute coronary syndrome (ACS) events in non-obese CAD patients. Methods. This study consisted of 517 non-obese CAD patients (368 men; age, 66 ± 10 years) who underwent serial multidetector computed tomography (MDCT) examinations to evaluate coronary atherosclerosis progression. The MDCT examination was used to assess the severity of stenosis, plaque characteristics, and EAT volume. All patients received comprehensive management to reduce CAD risk factors after the first MDCT examination. The MDCT examination was repeated at 6-24 months, and patients were followed-up for more than 1 year or until the occurrence of ACS events. Results. Of 517 patients, 159 (31%) patients were classified into increase of EAT volume during follow-up, 91 (18%) into decrease of EAT volume during follow-up, and 267 (51%) patients into constant of EAT volume during follow-up. The prevalence of obstructive plaques and MDCT-derived vulnerable features of coronary plaques were significantly elevated in patients with increase of EAT volume during follow-up. In contrast, no significant changes were observed in the other 2 groups. During the follow-up period of 4.1 ± 1.8 years (median 4.4 years) after the second MDCT examination, ACS occurred in 43 (8.3%) patients. Multivariate Cox regression analysis showed that the presence of low-attenuation plaque (hazard ratio [HR]; 1.78, p = 0.04) and napkin-ring sign (HR; 3.74, p < 0.001) at second MDCT examination, and changes of EAT volume per 10 ml (HR; 1.34, p = 0.004) were associated with future ACS events. Conclusion. Patients with increase of EAT volume during follow-up despite comprehensive management for CAD risks had an increased prevalence of obstructive plaques and plaques with high-risk features, which could be associated with unfavorable ACS outcomes in non-obese CAD patients.
目的。心外膜脂肪组织（EAT）被认为是冠状动脉疾病（CAD）的一种新的危险因素，并且其作用在非肥胖患者中被认为比肥胖患者更强。然而，在对动脉粥样硬化危险因素进行综合管理后，EAT积累进展的预后影响仍不清楚。本研究旨在调查随访期间EAT体积增加是否能预测非肥胖CAD患者未来的急性冠状动脉综合征（ACS）事件。方法。本研究纳入了517例非肥胖CAD患者（368例男性；年龄66±10岁），这些患者接受了系列多排螺旋计算机断层扫描（MDCT）检查以评估冠状动脉粥样硬化进展。MDCT检查用于评估狭窄程度、斑块特征和EAT体积。所有患者在首次MDCT检查后接受了综合管理以降低CAD危险因素。在6 - 24个月时重复进行MDCT检查，并对患者进行超过1年的随访或直至发生ACS事件。结果。在517例患者中，159例（31%）患者在随访期间EAT体积增加，91例（18%）患者在随访期间EAT体积减少，267例（51%）患者在随访期间EAT体积保持不变。随访期间EAT体积增加的患者中，阻塞性斑块的患病率以及MDCT衍生的冠状动脉斑块易损特征显著升高。相比之下，其他两组未观察到显著变化。在第二次MDCT检查后的4.1±1.8年（中位4.4年）随访期间，43例（8.3%）患者发生了ACS。多变量Cox回归分析显示，第二次MDCT检查时存在低衰减斑块（风险比[HR]；1.78，p = 0.04）和餐巾环征（HR；3.74，p < 0.001），以及每10 ml EAT体积的变化（HR；1.34，p = 0.004）与未来ACS事件相关。结论。尽管对CAD风险进行了综合管理，但随访期间EAT体积增加的患者阻塞性斑块和具有高危特征斑块的患病率增加，这可能与非肥胖CAD患者不良的ACS结局相关。
