Konishi Masaaki, Akiyama Eiichi, Suzuki Hiroyuki, Iwahashi Noriaki, Maejima Nobuhiko, Tsukahara Kengo, Hibi Kiyoshi, Kosuge Masami, Ebina Toshiaki, Matsuzawa Yasushi, Umemura Satoshi, Kimura Kazuo
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
J Cardiol. 2016 Jan;67(1):92-7. doi: 10.1016/j.jjcc.2015.03.016. Epub 2015 May 5.
Heart failure (HF) is associated with adverse metabolic influences and provokes fat loss as well as bone and muscle loss at the terminal stages. Pericardial fat is an ectopic fat depot that can potentially affect the myocardium, but the role of pericardial fat in HF is unclear. We sought to characterize pericardial fat in HF, particularly in association with bone tissue using cardiac computed tomography (CT).
In 61 consecutive hospitalized HF patients with left ventricular ejection fraction ≤50%, pericardial fat volume (PFV), CT density in the thoracic vertebrae, and ectopic calcification in the aortic valve were assessed simultaneously using electrocardiogram-gated non-contrast-enhanced CT.
The mean PFV was 93.5±50.6cm(3), which might reflect the total body fat measured with dual energy X-ray absorptiometry (Pearson's r=0.48, p=0.01). The PFV index, defined as the PFV/body surface area, was significantly higher among older patients (>65 years; 63.5±30.6cm(3)/m(2) vs. 42.7±17.1cm(3)/m(2), p<0.01) and among patients with atrial fibrillation (AF; 70.9±36.4cm(3)/m(2) vs. 48.8±21.2cm(3)/m(2), p<0.01) and hypertension (60.7±29.3cm(3)/m(2) vs. 41.5±18.2cm(3)/m(2), p<0.01) compared to patients without these conditions. The PFV indices were comparable between the patients with and without ischemic etiology, diabetes, and renal dysfunction. Patients with increased PFV indices (above the median) exhibited lower CT density in the thoracic vertebrae (134±41 Hounsfield units vs. 161±57 Hounsfield units, p=0.04), and were more likely to have aortic valve calcification (48% vs. 18%, p=0.02) and N-telopeptide (bone resorption marker; 20.7±5.2nmolBCE/mmolCr vs. 25.5±5.9nmolBCE/mmolCr, p=0.03) levels than those without increased PFV indices.
We simultaneously assessed the pericardial fat and bone tissue of HF patients with CT and successfully characterized AF, hypertension, and advanced age as factors that are associated with increased PFV. PFV was correlated with bone tissues and alterations in bone turnover.
心力衰竭（HF）与不良代谢影响相关，在疾病终末期会导致脂肪、骨骼和肌肉流失。心包脂肪是一种异位脂肪储存库，可能影响心肌，但心包脂肪在HF中的作用尚不清楚。我们试图通过心脏计算机断层扫描（CT）来描述HF患者的心包脂肪特征，尤其是与骨组织相关的特征。
对61例连续住院的左心室射血分数≤50%的HF患者，使用心电图门控非增强CT同时评估心包脂肪体积（PFV）、胸椎CT密度和主动脉瓣异位钙化情况。
平均PFV为93.5±50.6cm³，这可能反映了用双能X线吸收法测量的全身脂肪（Pearson相关系数r = 0.48，p = 0.01）。PFV指数定义为PFV/体表面积，在老年患者（>65岁；63.5±30.6cm³/m² 对 42.7±17.1cm³/m²，p<0.01）、心房颤动（AF）患者（70.9±36.4cm³/m² 对 48.8±21.2cm³/m²，p<0.01）和高血压患者（60.7±29.3cm³/m² 对 41.5±18.2cm³/m²，p<0.01）中显著高于无这些情况的患者。有无缺血病因、糖尿病和肾功能不全的患者之间PFV指数相当。PFV指数升高（高于中位数）的患者胸椎CT密度较低（134±41亨氏单位对161±57亨氏单位，p = 0.04），并且比PFV指数未升高的患者更可能有主动脉瓣钙化（48%对1
