磁共振成像定量检测心外膜脂肪组织堆积在透析患者舒张功能障碍中具有独立的风险。

Magnetic Resonance Imaging Quantification of Accumulation of Epicardial Adipose Tissue Adds Independent Risks for Diastolic Dysfunction among Dialysis Patients.

机构信息

Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.

Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.

出版信息

J Magn Reson Imaging. 2022 Oct;56(4):1184-1194. doi: 10.1002/jmri.28081. Epub 2022 Feb 21.

DOI:10.1002/jmri.28081

PMID:35188692

Abstract

BACKGROUND

Diastolic dysfunction (DD) frequently occurs in dialysis patients; however, the risk factors of DD remain to be further explored in such a population. Epicardial adipose tissue (EAT) volume has proven to be an independent clinical risk factor for multiple cardiac disorders.

PURPOSE

To assess whether EAT volume is an independent risk factor for DD in dialysis patients.

STUDY TYPE

Case-control study.

POPULATION

A total of 113 patients (mean age: 54.5 ± 14.4 years; 41 women) who had underwent dialysis for at least 3 months due to uremia.

FIELD STRENGTH

A 3 T, steady-state free precession (SSFP) sequence for cine imaging, modified Look-Locker imaging (MOLLI) for T1 mapping and gradient-recalled-echo for T2*.

ASSESSMENT

All participants were performed cardiac magnetic resonance imaging (MRI) and echocardiogram. For MRI images analysis, borders of the EAT were manually delineated, as well as, pericardial adipose tissue (PeAT) and paracardial adipose tissue (PaAT), T1 mapping, T2* mapping, global longitudinal strain (GLS), and left atrial strain. For echocardiogram assessments, the thickness of PaAT, e' velocity, E velocity, E/e ratio, A velocity, and deceleration time were measured.

STATISTICAL TESTS

Univariate and multivariate logistic regressions were performed to explore the independent risk factors for DD. P value less than 0.05 was considered as significant.

RESULTS

Compared with the DD(-) group, the DD(+) group had significantly more epicardial tissue fat (18.5 ± 1.3 vs. 30.9 ± 2.3) In addition, EAT volumes increased significantly with the grades of DD (grade 1 vs. grade 2 and 3: 27.9 ± 15.9 vs. 35.4 ± 13.1). Moreover, EAT had significant correlations with T1 mapping, T2* mapping, GLS, left atrial strain, e' velocity, and E/e ratio. EAT accumulation added an independent risk for DD (Odds Ratio = 1.03) over conventional clinical risk factors including age, diabetes mellitus, and hemodialysis.

DATA CONCLUSION

EAT was associated with diastolic function, and its accumulation may be an independent risk factor for DD among dialysis patients.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 2.

摘要

背景

舒张功能障碍（DD）在透析患者中经常发生；然而，这种人群中 DD 的风险因素仍需进一步探讨。心外膜脂肪组织（EAT）体积已被证明是多种心脏疾病的独立临床危险因素。

目的

评估 EAT 体积是否是透析患者 DD 的独立危险因素。

研究类型

病例对照研究。

人群

共 113 名患者（平均年龄：54.5±14.4 岁；41 名女性），因尿毒症至少接受 3 个月透析治疗。

磁场强度

3T、稳态自由进动（SSFP）序列用于电影成像、改良 Look-Locker 成像（MOLLI）用于 T1 映射和梯度回波用于 T2*。

评估

所有参与者均进行心脏磁共振成像（MRI）和超声心动图检查。对于 MRI 图像分析，手动描绘 EAT 边界，以及心包脂肪组织（PeAT）和心外膜脂肪组织（PaAT）、T1 映射、T2*映射、整体纵向应变（GLS）和左心房应变。对于超声心动图评估，测量 PaAT 厚度、e'速度、E 速度、E/e 比值、A 速度和减速时间。

统计检验

进行单变量和多变量逻辑回归以探讨 DD 的独立危险因素。P 值小于 0.05 被认为具有统计学意义。

结果

与 DD(-)组相比，DD(+)组的心外膜组织脂肪明显更多（18.5±1.3 与 30.9±2.3）。此外，EAT 体积随着 DD 程度的增加而显著增加（1 级与 2 级和 3 级：27.9±15.9 与 35.4±13.1）。此外，EAT 与 T1 映射、T2*映射、GLS、左心房应变、e'速度和 E/e 比值均有显著相关性。EAT 堆积增加了常规临床危险因素（年龄、糖尿病和血液透析）之外的 DD 发生的独立风险（优势比=1.03）。