心外膜脂肪组织体积增加与心力衰竭患者心脏去交感神经支配相关。
Increased Epicardial Adipose Tissue Volume Correlates With Cardiac Sympathetic Denervation in Patients With Heart Failure.
机构信息
From the Department of Translational Medical Sciences (V.P., G.R., G.P., G.D.F., L.P., G.G., A.C., N.F., D.L.) and Department of Advanced Biomedical Science (P.P.-F., T.P., A.C.), University Federico II, Naples, Italy; Department of Cardiology (G.R., G.G.) and Department of Neurology (M.N., A.E.), Salvatore Maugeri Foundation, IRCCS, Istituto di Telese, Benevento, Italy (G.R., G.G., M.N., A.E.); SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy (S.P.); Department of Cardiology and Cardiac Surgery, Casa di Cura San Michele, Maddaloni (CE), Italy (A.C., M.G.G., F.B., A.D.B.); Department of Cardiac Surgery, Ruggi D'Aragona Hospital, Salerno, Italy (E.C.); and Institute of Biostructure and Bioimaging Italian National Research Council (CNR), Naples, Italy (T.P.).
出版信息
Circ Res. 2016 Apr 15;118(8):1244-53. doi: 10.1161/CIRCRESAHA.115.307765. Epub 2016 Feb 29.
RATIONALE
It has been reported that epicardial adipose tissue (EAT) may affect myocardial autonomic function.
OBJECTIVE
The aim of this study was to explore the relationship between EAT and cardiac sympathetic nerve activity in patients with heart failure.
METHODS AND RESULTS
In 110 patients with systolic heart failure, we evaluated the correlation between echocardiographic EAT thickness and cardiac adrenergic nerve activity assessed by (123)I-metaiodobenzylguanidine ((123)I-MIBG). The predictive value of EAT thickness on cardiac sympathetic denervation ((123)I-MIBG early and late heart:mediastinum ratio and single-photon emission computed tomography total defect score) was tested in a multivariate analysis. Furthermore, catecholamine levels, catecholamine biosynthetic enzymes, and sympathetic nerve fibers were measured in EAT and subcutaneous adipose tissue biopsies obtained from patients with heart failure who underwent cardiac surgery. EAT thickness correlated with (123)I-MIBG early and late heart:mediastinum ratio and single-photon emission computed tomography total defect score, but not with left ventricular ejection fraction. Moreover, EAT resulted as an independent predictor of (123)I-MIBG early and late heart:mediastinum ratio and single-photon emission computed tomography total defect score and showed a significant additive predictive value on (123)I-MIBG planar and single-photon emission computed tomography results over demographic and clinical data. Although no differences were found in sympathetic innervation between EAT and subcutaneous adipose tissue, EAT showed an enhanced adrenergic activity demonstrated by the increased catecholamine levels and expression of catecholamine biosynthetic enzymes.
CONCLUSIONS
This study provides the first evidence of a direct correlation between increased EAT thickness and cardiac sympathetic denervation in heart failure.
背景
据报道，心外膜脂肪组织（EAT）可能影响心肌自主功能。
目的
本研究旨在探讨心力衰竭患者 EAT 与心脏交感神经活性的关系。
方法和结果
在 110 例收缩性心力衰竭患者中，我们评估了超声心动图 EAT 厚度与（123）I-间位碘代苄胍（（123）I-MIBG）评估的心脏肾上腺素能神经活性之间的相关性。在多变量分析中测试了 EAT 厚度对心脏交感神经去神经支配（（123）I-MIBG 早期和晚期心脏：纵隔比和单光子发射计算机断层扫描总缺损评分）的预测价值。此外，从接受心脏手术的心力衰竭患者中获取 EAT 和皮下脂肪组织活检，测量儿茶酚胺水平、儿茶酚胺生物合成酶和交感神经纤维。EAT 厚度与（123）I-MIBG 早期和晚期心脏：纵隔比和单光子发射计算机断层扫描总缺损评分相关，但与左心室射血分数无关。此外，EAT 是（123）I-MIBG 早期和晚期心脏：纵隔比和单光子发射计算机断层扫描总缺损评分的独立预测因子，并且在（123）I-MIBG 平面和单光子发射计算机断层扫描结果上具有显著的附加预测价值，超过了人口统计学和临床数据。尽管 EAT 和皮下脂肪组织之间的交感神经支配没有差异，但 EAT 显示出增强的肾上腺素能活性，表现为儿茶酚胺水平和儿茶酚胺生物合成酶的表达增加。
结论
本研究首次提供了证据表明心力衰竭患者中 EAT 厚度增加与心脏交感神经去神经支配直接相关。
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