Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
PLoS One. 2020 Mar 2;15(3):e0229636. doi: 10.1371/journal.pone.0229636. eCollection 2020.
Aortic stenosis (AS) may lead to diastolic dysfunction and later on heart failure (HF) with preserved left ventricular ejection fraction (HFpEF) via increased afterload and left-ventricular (LV) hypertrophy. Since epicardial adipose tissue (EAT) is a metabolically active fat depot that is adjacent to the myocardium and can influence cardiomyocytes and LV function via secretion of proinflammatory cytokines, we hypothesized that high amounts of EAT, as assessed by computed tomography (CT), may aggravate the development and severity of LV hypertrophy and diastolic dysfunction in the context of AS.
We studied 50 patients (mean age 71 ± 9 years; 9 women) in this preliminary study with mild or moderate AS and mild to severe LV diastolic dysfunction (LVDD), diagnosed by echocardiography, who underwent non-contrast cardiac CT and echocardiography. EAT parameters were measured on 2nd generation dual source CT. Conventional two-dimensional echocardiography and Tissue Doppler Imaging (TDI) was performed to assess LV function and to derive myocardial straining parameter. All patients had a preserved LV ejection fraction > 50%. Data was analysed using Pearson's correlation.
Only weak correlation was found between EAT volume or density and E/é ratio as LVDD marker (r = -.113 p = .433 and r = .260, p = .068 respectively). Also, EAT volume or density were independent from Global Strain Parameters (r = 0.058 p = .688 and r = -0.207 p = .239). E/é ratio was strongly associated with LVDD (r = .761 p≤0.0001) and Strain Parameters were moderately associated with LV Ejection Fraction (r = -.669 p≤0.001 and r = -.454 P≤0.005).
In this preliminary study in patients with AS, the EAT volume and density as assessed by CT correlated only weakly with LVDD, as expressed by the commonly used E/é ratio, and with LV strain function. Hence, measuring EAT volume and density may neither contribute to the prediction nor upon the severity of LVDD, respectively.
主动脉瓣狭窄（AS）可通过增加后负荷和左心室（LV）肥厚导致舒张功能障碍，进而导致射血分数保留的心力衰竭（HFpEF）。由于心外膜脂肪组织（EAT）是一种紧邻心肌的代谢活跃的脂肪库，可通过分泌促炎细胞因子影响心肌细胞和 LV 功能，我们假设通过计算机断层扫描（CT）评估的大量 EAT 可能会加重 AS 背景下 LV 肥厚和舒张功能障碍的发展和严重程度。
我们在这项初步研究中研究了 50 名患者（平均年龄 71 ± 9 岁；9 名女性），这些患者患有轻度或中度 AS 和轻度至重度 LV 舒张功能障碍（LVDD），通过超声心动图诊断，并接受了非对比心脏 CT 和超声心动图检查。使用第二代双源 CT 测量 EAT 参数。进行常规二维超声心动图和组织多普勒成像（TDI）以评估 LV 功能并得出心肌应变参数。所有患者的 LV 射血分数均> 50%。使用 Pearson 相关性分析数据。
仅发现 EAT 体积或密度与作为 LVDD 标志物的 E/é 比值之间存在弱相关性（r = -.113，p =.433 和 r =.260，p =.068）。此外，EAT 体积或密度与整体应变参数无关（r = 0.058，p =.688 和 r = -0.207，p =.239）。E/é 比值与 LVDD 强烈相关（r =.761，p≤0.0001），应变参数与 LV 射血分数中度相关（r = -.669，p≤0.001 和 r = -.454，p≤0.005）。
在这项初步研究中，患有 AS 的患者中，CT 评估的 EAT 体积和密度与常用的 E/é 比值和 LV 应变功能仅表现出 LVDD 的弱相关性。因此，测量 EAT 体积和密度既不能预测 LVDD 的严重程度，也不能预测 LVDD 的严重程度。
