Morales-Portano Julieta D, Peraza-Zaldivar Juan Ángel, Suárez-Cuenca Juan A, Aceves-Millán Rocío, Amezcua-Gómez Lilia, Ixcamparij-Rosales Carlos H, Trujillo-Cortés Rafael, Robledo-Nolasco Rogelio, Mondragón-Terán Paul, Pérez-Cabeza de Vaca Rebeca, Hernández-Muñoz Rolando, Melchor-López Alberto, Vannan Mani A, Rubio-Guerra Alberto Francisco
Departments of Echocardiography, Hemodynamics and Cardiology. Centro Médico Nacional "20 de Noviembre", ISSSTE, Mexico City, Mexico.
Department of Clinical Research, Centro Médico Nacional "20 de Noviembre", ISSSTE, 502, San Lorenzo, Col. Del Valle; Del. Benito Juárez, 03100, Mexico City, Mexico.
Int J Cardiovasc Imaging. 2018 Sep;34(9):1429-1437. doi: 10.1007/s10554-018-1360-y. Epub 2018 May 2.
The present study aimed to compare echocardiography measurements of epicardial adipose tissue (EAT) thickness and other risk factors regarding their ability to predict adverse cardiovascular outcomes in patients with coronary artery disease (CAD). Outcomes of 107 patients (86 males, 21 females, mean age 63.6 years old) submitted to diagnostic echocardiography and coronary angiography were prospectively analyzed. EAT (measures over the right ventricle, interventricular groove and complete bulk of EAT) and left ventricle ejection fraction (LVEF) were performed by echocardiography. Coronary complexity was evaluated by Syntax score. Primary endpoints were major adverse cardiovascular events (MACE's), composite of cardiovascular death, myocardial infarction, unstable angina, intra-stent re-stenosis and episodes of decompensate heart failure requiring hospital attention during a mean follow up of 15.94 ± 3.6 months. Mean EAT thickness was 4.6 ± 1.9 mm; and correlated with Syntax score and body mass index; negatively correlated with LVEF. Twenty-three cases of MACE's were recorded during follow up, who showed higher EAT. Diagnostic ability of EAT to discriminate MACE's was comparable to LVEF (AUROC > 0.5); but higher than Syntax score. Quartile comparison of EAT revealed that measurement of the complete bulk of EAT provided a better discrimination range for MACE's, and higher, more significant adjusted risk (cutoff 4.6 mm, RR = 3.91; 95% CI 1.01-15.08; p = 0.04) than the other risk factors. We concluded that echocardiographic measurement of EAT showed higher predicting ability for MACE's than the other markers tested, in patients with CAD. Whether location for echocardiographic measurement of EAT impacts the diagnostic performance of this method deserves further study.
本研究旨在比较心外膜脂肪组织（EAT）厚度的超声心动图测量值与其他风险因素预测冠状动脉疾病（CAD）患者不良心血管结局的能力。对107例接受诊断性超声心动图和冠状动脉造影的患者（86例男性，21例女性，平均年龄63.6岁）的结局进行了前瞻性分析。通过超声心动图测量EAT（在右心室、室间沟及整个EAT上进行测量）和左心室射血分数（LVEF）。通过Syntax评分评估冠状动脉复杂性。主要终点是主要不良心血管事件（MACE），即在平均15.94±3.6个月的随访期间，心血管死亡、心肌梗死、不稳定型心绞痛、支架内再狭窄以及需要住院治疗的失代偿性心力衰竭发作的综合情况。EAT平均厚度为4.6±1.9mm；与Syntax评分和体重指数相关；与LVEF呈负相关。随访期间记录到23例MACE病例，这些病例的EAT较高。EAT鉴别MACE的诊断能力与LVEF相当（曲线下面积>0.5）；但高于Syntax评分。EAT的四分位数比较显示，测量整个EAT对MACE的鉴别范围更好，且调整后的风险更高、更显著（临界值4.6mm，相对危险度=3.91；95%可信区间1.01 - 15.08；p=0.04），高于其他风险因素。我们得出结论，在CAD患者中，EAT的超声心动图测量对MACE的预测能力高于其他测试指标。EAT超声心动图测量的位置是否会影响该方法的诊断性能值得进一步研究。
