在一个多样化的有症状患者群体中，心外膜脂肪体积与冠状动脉钙化程度、冠状动脉疾病严重程度或心肌灌注异常的存在之间缺乏关联：CORE320多中心研究结果
Lack of association between epicardial fat volume and extent of coronary artery calcification, severity of coronary artery disease, or presence of myocardial perfusion abnormalities in a diverse, symptomatic patient population: results from the CORE320 multicenter study.
作者信息
Tanami Yutaka, Jinzaki Masahiro, Kishi Satoru, Matheson Matthew, Vavere Andrea L, Rochitte Carlos E, Dewey Marc, Chen Marcus Y, Clouse Melvin E, Cox Christopher, Kuribayashi Sachio, Lima Joao A C, Arbab-Zadeh Armin
机构信息
From the Department of Radiology, Keio University, Tokyo, Japan (Y.T., M.J., S.Kuribayashi); Department of Medicine/Cardiology (S.Kishi, A.L.V., J.A.C.L., A.A.-Z.) and Department of Epidemiology, Bloomberg School of Public Health (M.M., C.C.), Johns Hopkins University, Baltimore, MD; Department of Medicine/Cardiology, InCor Heart Institute, Sao Paulo, Brazil (C.E.R.); Department of Radiology, Charité University Hospital, Berlin, Germany (M.D.); Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (M.E.C.).
出版信息
Circ Cardiovasc Imaging. 2015 Mar;8(3):e002676. doi: 10.1161/CIRCIMAGING.114.002676.
BACKGROUND
Epicardial fat may play a role in the pathogenesis of coronary artery disease (CAD). We explored the relationship of epicardial fat volume (EFV) with the presence and severity of CAD or myocardial perfusion abnormalities in a diverse, symptomatic patient population.
METHODS AND RESULTS
Patients (n=380) with known or suspected CAD who underwent 320-detector row computed tomographic angiography, nuclear stress perfusion imaging, and clinically driven invasive coronary angiography for the CORE320 international study were included. EFV was defined as adipose tissue within the pericardial borders as assessed by computed tomography using semiautomatic software. We used linear and logistic regression models to assess the relationship of EFV with coronary calcium score, stenosis severity by quantitative coronary angiography, and myocardial perfusion abnormalities by single photon emission computed tomography (SPECT). Median EFV among patients (median age, 62.6 years) was 102 cm(3) (interquartile range: 53). A coronary calcium score of ≥1 was present in 83% of patients. Fifty-nine percent of patients had ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography, and 49% had abnormal myocardial perfusion results by SPECT. There were no significant associations between EFV and coronary artery calcium scanning, presence severity of ≥50% stenosis by quantitative coronary angiography, or abnormal myocardial perfusion by SPECT.
CONCLUSIONS
In a diverse population of symptomatic patients referred for invasive coronary angiography, we did not find associations of EFV with the presence and severity of CAD or with myocardial perfusion abnormalities. The clinical significance of quantifying EFV remains uncertain but may relate to the pathophysiology of acute coronary events rather than the presence of atherosclerotic disease.
背景
心外膜脂肪可能在冠状动脉疾病（CAD）的发病机制中起作用。我们在一个多样化的有症状患者群体中探讨了心外膜脂肪体积（EFV）与CAD的存在、严重程度或心肌灌注异常之间的关系。
方法和结果
纳入了CORE320国际研究中已知或疑似CAD且接受了320排计算机断层血管造影、核素负荷灌注成像以及临床驱动的有创冠状动脉造影的患者（n = 380）。EFV定义为通过使用半自动软件的计算机断层扫描评估的心包边界内的脂肪组织。我们使用线性和逻辑回归模型来评估EFV与冠状动脉钙化积分、定量冠状动脉造影的狭窄严重程度以及单光子发射计算机断层扫描（SPECT）的心肌灌注异常之间的关系。患者（中位年龄62.6岁）的EFV中位数为102 cm³（四分位间距：53）。83%的患者冠状动脉钙化积分≥1。59%的患者通过定量冠状动脉造影显示有≥1处冠状动脉狭窄≥50%，49%的患者SPECT心肌灌注结果异常。EFV与冠状动脉钙化扫描、定量冠状动脉造影显示的≥50%狭窄的存在及严重程度或SPECT心肌灌注异常之间均无显著关联。
结论
在转诊进行有创冠状动脉造影的多样化有症状患者群体中，我们未发现EFV与CAD的存在、严重程度或心肌灌注异常之间存在关联。量化EFV的临床意义仍不确定，但可能与急性冠状动脉事件的病理生理学有关，而非与动脉粥样硬化疾病的存在有关。
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