Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia.
Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia.
Can J Cardiol. 2016 Dec;32(12):1485-1492. doi: 10.1016/j.cjca.2016.06.009. Epub 2016 Jun 23.
Although epicardial adipose tissue (EAT) volume is associated with increased incidence of coronary artery disease (CAD), its role in myocardial systolic dysfunction is unclear. The present study aimed to identify independent determinants of EAT volume in patients without obstructive CAD, and to evaluate the association between EAT volume (vs other measures of obesity) and myocardial systolic strain analysis.
We prospectively recruited 130 patients without obstructive CAD on contrast-enhanced cardiac computed tomography imaging and normal left ventricular ejection fraction on 3-dimensional (3D) echocardiography. EAT volume was quantified from cardiac computed tomography imaging, and 3D multidirectional (longitudinal, circumferential, radial, and area) strain were measured.
The mean EAT volume was 97.5 ± 43.7 cm. In multivariable analysis, measures of obesity (body mass index [P = 0.007] and waist/hip ratio [P = 0.001]) were independently associated with larger EAT volume. EAT volume was correlated with 3D global longitudinal (r = 0.601; P < 0.001), circumferential (r = 0.375; P < 0.001), radial (r = -0.546; P < 0.001), and area (r = 0.558; P < 0.001) strain. In multivariable analyses, epicardial fat volume was the strongest predictor of 3D global longitudinal (standardized β = 0.512; P < 0.001), circumferential (standardized β = 0.242; P = 0.006), radial (standardized β = -0.422; P < 0.001), and area (standardized β = 0.428; P < 0.001) strain. In contrast, other measures of obesity including body mass index and waist/hip ratio were not independent determinants of 3D multidirectional global strain (all P > 0.05).
EAT volume is independently associated with impaired myocardial systolic function despite preserved 3D left ventricular ejection fraction and absence of obstructive CAD, and might play a significant role in the pathophysiology of diabetic, obesity, and metabolic heart disease.
尽管心外膜脂肪组织（EAT）体积与冠状动脉疾病（CAD）发生率增加有关，但它在心肌收缩功能障碍中的作用尚不清楚。本研究旨在确定无阻塞性 CAD 患者 EAT 体积的独立决定因素，并评估 EAT 体积（与其他肥胖测量指标相比）与心肌收缩应变分析之间的关系。
我们前瞻性地招募了 130 名在对比增强心脏计算机断层扫描成像上无阻塞性 CAD 和三维（3D）超声心动图上正常左心室射血分数的患者。从心脏计算机断层扫描成像中定量 EAT 体积，并测量 3D 多向（纵向、周向、径向和面积）应变。
EAT 体积的平均值为 97.5±43.7cm。多变量分析显示，肥胖指标（体重指数[P=0.007]和腰围/臀围比[P=0.001]）与较大的 EAT 体积独立相关。EAT 体积与 3D 整体纵向应变（r=0.601；P<0.001）、周向应变（r=0.375；P<0.001）、径向应变（r=-0.546；P<0.001）和面积应变（r=0.558；P<0.001）呈正相关。在多变量分析中，心外膜脂肪体积是 3D 整体纵向应变（标准化β=0.512；P<0.001）、周向应变（标准化β=0.242；P=0.006）、径向应变（标准化β=-0.422；P<0.001）和面积应变（标准化β=0.428；P<0.001）的最强预测因子。相比之下，包括体重指数和腰围/臀围比在内的其他肥胖指标并不是 3D 多向整体应变的独立决定因素（所有 P>0.05）。
尽管 3D 左心室射血分数正常且无阻塞性 CAD，但 EAT 体积与心肌收缩功能障碍独立相关，并且可能在糖尿病、肥胖和代谢性心脏病的病理生理学中发挥重要作用。
