Iwasaki Kohichiro, Urabe Norio, Kitagawa Atsushi, Nagao Toshihiko
Department of Cardiology, Ako Central Hospital, 52-6, Soumonchou, Ako, Japan.
Int J Cardiovasc Imaging. 2018 Feb;34(2):301-309. doi: 10.1007/s10554-017-1227-7. Epub 2017 Aug 14.
Recent studies have demonstrated the relationship between epicardial fat volume (EFV) and coronary atherosclerosis, but their association is modest at best. Our purpose is to elucidate the association of epicardial fat with coronary characteristics and clinical outcome. We performed coronary computed tomographic angiography in 651 patients and divided them into three groups according to tertiles of EFV; low-tertile (n = 215), 36-123 ml; middle-tertile (n = 218), 124-165 ml; high-tertile (n = 218), 166-489 ml. The prevalence of coronary calcium score (CCS) >0 (71.6, 73.4, and 83.9% in low-, middle-, and high-tertile group, respectively) and CCS >100 (39.1, 39.9, and 59.2% in each group) was significantly higher in patients with high-tertile EFV compared to the other two groups (p = 0.0047 and p < 0.0001, respectively). The prevalence of CCS >400 was 17.2, 25.7, and 33.1% in each group, which increased stepwise as EFV increased. The significant stenosis (36.2 vs. 27.0%, p = 0.0383), total coronary occlusion (5.5 vs. 0.9%, p = 0.0156), and high-risk plaque (11.0 vs. 5.6%, p = 0.0368) were more prevalent in patients with high-tertile EFV compared to those with low-tertile EFV. The combined rate of cardiac death and myocardial infarction was 0.9, 2.3, and 6.4% in each patient group, respectively, which was significantly higher in patients with high-tertile EFV compared to those with low-tertile EFV (p = 0.0004). The prevalence of coronary artery calcium, significant stenosis, and high-risk plaque increased sharply in patients with high EFV, which was associated with higher rate of cardiac death and myocardial infarction. Thus, high EFV was associated with advanced coronary atherosclerosis and poor prognosis.
近期研究已证实心外膜脂肪体积（EFV）与冠状动脉粥样硬化之间的关系，但它们之间的关联充其量也很微弱。我们的目的是阐明心外膜脂肪与冠状动脉特征及临床结局之间的关联。我们对651例患者进行了冠状动脉计算机断层血管造影，并根据EFV三分位数将他们分为三组；低三分位数组（n = 215），36 - 123毫升；中三分位数组（n = 218），124 - 165毫升；高三分位数组（n = 218），166 - 489毫升。冠状动脉钙化积分（CCS）>0（低、中、高三分位数组分别为71.6%、73.4%和83.9%）以及CCS>100（每组分别为39.1%、39.9%和59.2%）的患病率，高三分位数EFV患者显著高于其他两组（p分别为0.0047和p<0.0001）。每组CCS>400的患病率分别为17.2%、25.7%和33.1%，随EFV增加而逐步升高。与低三分位数EFV患者相比，高三分位数EFV患者的显著狭窄（36.2%对27.0%，p = 0.0383）、冠状动脉完全闭塞（5.5%对0.9%，p = 0.0156）和高危斑块（11.0%对5.6%，p = 0.0368）更为普遍。每组患者中心脏死亡和心肌梗死的合并发生率分别为0.9%、2.3%和6.4%，高三分位数EFV患者显著高于低三分位数EFV患者（p = 0.0004）。EFV高的患者冠状动脉钙化、显著狭窄和高危斑块的患病率急剧增加，这与更高的心源性死亡和心肌梗死发生率相关。因此，高EFV与晚期冠状动脉粥样硬化及不良预后相关。
