心外膜脂肪组织体积可预测 2 型糖尿病患者的长期主要不良心血管事件。

Epicardial adipose tissue volume predicts long term major adverse cardiovascular events in patients with Type 2 diabetes.

机构信息

Department of Cardiology, University of Health Sciences İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.

Department of Radiology, Bezmialem Vakıf University Hospital, İstanbul, Turkey.

出版信息

Turk Kardiyol Dern Ars. 2021 Mar;49(2):127-134. doi: 10.5543/tkda.2021.65635.

DOI:10.5543/tkda.2021.65635

PMID:33709918

Abstract

OBJECTIVE

Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot that plays an important role in coronary atherosclerosis. In this study, our aim was to investigate the relationship between long-term major adverse cardiovascular events (MACEs) and EAT volume detected by coronary computed tomography angiography (CCTA) in patients with Type 2 diabetes mellitus (T2-DM) without previous coronary events.

METHODS

A total of 127 patients with diabetes who underwent CCTA between 2012 and 2014 were enrolled retrospectively. The study population was divided into 2 groups according to whether they experienced or did not experience MACE, which was defined as cardiac death, non-fatal myocardial infarction or unstable angina requiring hospitalization, coronary revascularizations (percutaneous coronary intervention or coronary artery bypass grafting surgery), heart failure, peripheral arterial disease, or ischemic stroke. In both groups, EAT volumes were measured by CCTA.

RESULTS

During 60±7 months follow-up period, 22 participants experienced MACEs. Data were evaluated with univariate and multivariate analyses and receiver operating characteristic (ROC) analysis. Age, male sex, coronary artery disease, hemoglobin A1c, glucose, creatinine, C- reactive protein, and cholesterol levels were found to be associated with MACE. EAT volume (odds ratio [OR]: 1.027; 95% confidence interval [CI]: 1.010‒1.044, p=0.002) and low-density lipoprotein (OR: 1.015; 95% CI: 1.000‒1.030, p=0.050) were found to be independent predictors for MACE. ROC analysis indicated that EAT volumes >123.2 mL had a 72.7% sensitivity and a 77.1% specificity for predicting long-term MACE in patients with T2-DM (area under the curve: 0.820; 95% CI: 0.733-0.908).

CONCLUSION

EAT volume is an independent predictor of long-term MACE in patients with T2-DM without previous coronary events. EAT volume may be used additionally in risk stratification for MACE besides the well-known vascular risk factors in patients with T2-DM.

摘要

目的

心外膜脂肪组织（EAT）是一种代谢活跃的内脏脂肪库，在心外膜脂肪组织在冠状动脉粥样硬化中起着重要作用。在这项研究中，我们的目的是研究在没有先前冠状动脉事件的 2 型糖尿病（T2-DM）患者中，通过冠状动脉计算机断层扫描血管造影（CCTA）检测到的 EAT 体积与长期主要不良心血管事件（MACE）之间的关系。

方法

回顾性纳入了 2012 年至 2014 年间接受 CCTA 的 127 名糖尿病患者。根据是否发生 MACE 将研究人群分为两组，MACE 定义为心脏死亡、非致死性心肌梗死或需要住院的不稳定型心绞痛、冠状动脉血运重建（经皮冠状动脉介入治疗或冠状动脉旁路移植术）、心力衰竭、外周动脉疾病或缺血性中风。在两组中，均通过 CCTA 测量 EAT 体积。

结果

在 60±7 个月的随访期间，22 名参与者发生了 MACE。使用单变量和多变量分析以及接受者操作特征（ROC）分析进行数据分析。年龄、男性、冠状动脉疾病、糖化血红蛋白、血糖、肌酐、C 反应蛋白和胆固醇水平与 MACE 相关。EAT 体积（比值比 [OR]：1.027；95%置信区间 [CI]：1.010-1.044，p=0.002）和低密度脂蛋白（OR：1.015；95%CI：1.000-1.030，p=0.050）被发现是 MACE 的独立预测因素。ROC 分析表明，EAT 体积>123.2mL 对预测 T2-DM 患者的长期 MACE 具有 72.7%的敏感性和 77.1%的特异性（曲线下面积：0.820；95%CI：0.733-0.908）。