冠状动脉血管周围心外膜脂肪组织与 ST 段抬高型心肌梗死后主要不良心血管事件。
Coronary perivascular epicardial adipose tissue and major adverse cardiovascular events after ST segment-elevation myocardial infarction.
机构信息
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
出版信息
Atherosclerosis. 2020 Jun;302:27-35. doi: 10.1016/j.atherosclerosis.2020.04.012. Epub 2020 Apr 29.
BACKGROUND AND AIMS
Perivascular epicardial adipose tissue (pEAT) plays a key role in the progression of atherosclerosis, plaque rupture, and thrombosis. However, the relationship between pEAT and prognosis after revascularization of ST-segment elevation myocardial infarction (STEMI) is unknown. This study aimed to investigate the relationship between pEAT thickness and prognosis after STEMI.
METHODS
We studied 180 STEMI patients (mean age 59.4 ± 13.3 years, 78.9% male) who underwent cardiac magnetic resonance (CMR) imaging within 1 week of prompt infarct-related artery revascularization and 52 age/sex/body mass index-matched controls (mean age 59.9 ± 13.5 years, 78.9% male). pEAT thickness indexed to body surface area at five locations, infarct size, left ventricular ejection fraction (LVEF), and coronary microvascular obstruction (MVO) were evaluated by CMR. Associations between pEAT index and 1-year composite major adverse cardiovascular events (MACE), infarct size, LVEF, and MVO were analyzed.
RESULTS
Mean pEAT indices were significantly higher in STEMI patients than controls. In STEMI patients, higher pEAT indices at the superior and inferior interventricular groove (SIVG and IIVG, respectively) were significantly associated with larger infarct size, higher prevalence of MVO, and inversely correlated with post-infarct LVEF. SIVG pEAT index was an independent predictor of composite MACE in post-STEMI patients with an odds ratio of 2.26 (95% confidence interval 1.63-3.13; p < 0.0001) after adjustment for age, sex, LVEF, and 2.71 (95% confidence interval 1.93-3.80; p < 0.0001) after adjustment for age, sex, previous myocardial infarction, diabetes mellitus, and renal function.
CONCLUSIONS
STEMI patients have significantly higher pEAT indices than controls. SIVG pEAT index independently predicts composite MACE in revascularized STEMI patients, underscoring the potentially prognostic value of this variable.
背景与目的
血管周围心外膜脂肪组织（pEAT）在动脉粥样硬化进展、斑块破裂和血栓形成中起着关键作用。然而，pEAT 与 ST 段抬高型心肌梗死（STEMI）血运重建后的预后之间的关系尚不清楚。本研究旨在探讨 pEAT 厚度与 STEMI 后的预后之间的关系。
方法
我们研究了 180 例 STEMI 患者（平均年龄 59.4±13.3 岁，78.9%为男性），他们在及时行梗死相关动脉血运重建后 1 周内行心脏磁共振（CMR）成像，以及 52 名年龄/性别/体重指数匹配的对照组（平均年龄 59.9±13.5 岁，78.9%为男性）。通过 CMR 评估 pEAT 厚度与五个部位的体表面积指数、梗死面积、左心室射血分数（LVEF）和冠状动脉微血管阻塞（MVO）的关系。分析 pEAT 指数与 1 年复合主要不良心血管事件（MACE）、梗死面积、LVEF 和 MVO 之间的相关性。
结果
STEMI 患者的平均 pEAT 指数明显高于对照组。在 STEMI 患者中，较高的上、下室间沟（SIVG 和 IIVG）pEAT 指数与较大的梗死面积、较高的 MVO 发生率显著相关，且与梗死后 LVEF 呈负相关。SIVG pEAT 指数是 STEMI 患者发生复合 MACE 的独立预测因子，调整年龄、性别、LVEF 后比值比为 2.26（95%置信区间 1.63-3.13；p<0.0001），调整年龄、性别、既往心肌梗死、糖尿病和肾功能后比值比为 2.71（95%置信区间 1.93-3.80；p<0.0001）。
结论
STEMI 患者的 pEAT 指数明显高于对照组。SIVG pEAT 指数独立预测血运重建后的 STEMI 患者的复合 MACE，强调了该变量的潜在预后价值。
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