Department of Cardiology, Bichat Hospital, 75018 Paris, France; Université de Paris, UMRS1148, INSERM, 75018 Paris, France; Université de Paris, 75006 Paris, France.
Department of Cardiology, Bichat Hospital, 75018 Paris, France; Université de Paris, 75006 Paris, France.
Arch Cardiovasc Dis. 2019 Oct;112(10):594-603. doi: 10.1016/j.acvd.2019.06.005. Epub 2019 Sep 4.
The severity of left ventricular (LV) remodelling is only partially related to the severity of aortic valve stenosis; additional factors, including diabetes, insulin resistance, obesity and metabolic syndrome, may play important roles. Epicardial adipose tissue (EAT), now considered as a metabolically active organ, is also linked to these factors.
To analyse the association between EAT volume measured using computed tomography and LV remodelling in a prospective cohort of patients with aortic stenosis.
Consecutive asymptomatic patients with at least mild degenerative aortic stenosis enrolled in a prospective cohort that aimed to assess the determinants of aortic stenosis occurrence and progression constituted our population.
We enrolled 143 patients (78±5 years; 65% men). Mean LV mass and EAT volume were 219±64g and 134±56mL, respectively. LV hypertrophy was diagnosed in 86 patients (60%), and concentric hypertrophy (32%) was the main remodelling pattern. EAT was associated with body mass index (P<0.001) and body surface area (P<0.001), but not with age (P=0.33) or aortic stenosis severity (all P>0.10). EAT was correlated with LV mass (r=0.41; P<0.0001), and after adjustment for age, sex, body mass index/body surface area, hypertension, waist circumference, low-density lipoprotein cholesterol and aortic stenosis severity, EAT was independently associated with LV mass (P=0.01/P=0.02). Similar results were found when EAT and LV mass index (adjusted for body surface area) were considered instead of absolute values (P=0.04).
In this prospective cohort of patients with aortic stenosis, EAT volume was independently associated with LV mass. Further studies are warranted to elucidate the underlying mechanisms of this link.
左心室（LV）重构的严重程度仅部分与主动脉瓣狭窄的严重程度相关；其他因素，包括糖尿病、胰岛素抵抗、肥胖和代谢综合征，可能也发挥着重要作用。心外膜脂肪组织（EAT），现被认为是一种代谢活跃的器官，也与这些因素有关。
使用计算机断层扫描分析主动脉瓣狭窄患者前瞻性队列中 EAT 体积与 LV 重构之间的关系。
连续纳入至少患有轻度退行性主动脉瓣狭窄的无症状患者，这些患者参加了一个前瞻性队列，旨在评估主动脉瓣狭窄发生和进展的决定因素。
共纳入 143 例患者（78±5 岁；65%为男性）。平均 LV 质量和 EAT 体积分别为 219±64g 和 134±56mL。86 例（60%）患者诊断为 LV 肥厚，以向心性肥厚（32%）为主。EAT 与体重指数（P<0.001）和体表面积（P<0.001）相关，但与年龄（P=0.33）或主动脉瓣狭窄严重程度无关（所有 P>0.10）。EAT 与 LV 质量呈正相关（r=0.41；P<0.0001），在校正年龄、性别、体重指数/体表面积、高血压、腰围、低密度脂蛋白胆固醇和主动脉瓣狭窄严重程度后，EAT 与 LV 质量独立相关（P=0.01/P=0.02）。当考虑 EAT 和 LV 质量指数（按体表面积校正）而不是绝对值时，也得到了相似的结果（P=0.04）。
在本项主动脉瓣狭窄患者的前瞻性队列中，EAT 体积与 LV 质量独立相关。需要进一步的研究来阐明这种关联的潜在机制。
