Yang Ming-Chun, Liu Hsien-Kuan, Tsai Ching-Chung, Su Yu-Tsun, Wu Jiunn-Ren
Department of Pediatrics, E-Da Hospital.
College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Acta Cardiol Sin. 2022 Sep;38(5):601-611. doi: 10.6515/ACS.202209_38(5).20220331B.
Epicardial adipose tissue (EAT) is increased in adolescents with obesity and may play a role in early cardiovascular pathophysiological changes. There is a lack of evidence focusing on the association between EAT and cardiac function in adolescents. This study explored associations between EAT, left ventricle (LV) geometric, and LV functional changes in adolescents.
Adolescent volunteers between 10 and 20 years of age were included. Body mass index (BMI) was presented as age- and sex-specific BMI z-scores. Blood samples for glucose metabolism, lipid profiles, and high-sensitivity C-reactive protein (hs-CRP) were obtained. EAT thickness, LV hypertrophy, and LV diastolic function were measured by echocardiography.
The mean age of the 276 adolescents was 13.51 ± 2.44 years. BMI z-score was strongly associated with EAT thickness (r = 0.77; p < 0.001). Multivariable analysis revealed that age, insulin resistance, total cholesterol to high-density lipoprotein cholesterol ratio, and hs-CRP were independent predictors of increased EAT thickness. After adjusting for sex, age, and BMI z-score by multivariable analysis, EAT thickness was a strong predictor of higher LV mass indexed to height, higher relative wall thickness, lower mitral annulus e'/a', and higher E/e' of the mitral annulus. There was no association between EAT and LV ejection fraction.
EAT was highly associated with LV hypertrophy and reduction in LV diastolic function, independent of BMI z-score in the enrolled adolescents. Of note, the negative impacts of EAT on LV geometry and diastolic function occurred as early as in adolescence. This highlights the importance of preventing obesity and EAT deposition early in life.
肥胖青少年的心外膜脂肪组织（EAT）增多，可能在早期心血管病理生理变化中起作用。目前缺乏关于青少年EAT与心脏功能之间关联的证据。本研究探讨了青少年EAT、左心室（LV）几何形态及LV功能变化之间的关联。
纳入10至20岁的青少年志愿者。体重指数（BMI）以年龄和性别特异性BMI z评分表示。采集用于葡萄糖代谢、血脂谱和高敏C反应蛋白（hs-CRP）检测的血样。通过超声心动图测量EAT厚度、LV肥厚及LV舒张功能。
276名青少年的平均年龄为13.51±2.44岁。BMI z评分与EAT厚度密切相关（r = 0.77；p < 0.001）。多变量分析显示，年龄、胰岛素抵抗、总胆固醇与高密度脂蛋白胆固醇比值及hs-CRP是EAT厚度增加的独立预测因素。在通过多变量分析校正性别、年龄和BMI z评分后，EAT厚度是较高的身高指数化LV质量、较高的相对壁厚度、较低的二尖瓣环e'/a'及较高的二尖瓣环E/e'的强预测因素。EAT与LV射血分数之间无关联。
在纳入的青少年中，EAT与LV肥厚及LV舒张功能降低高度相关，独立于BMI z评分。值得注意的是，EAT对LV几何形态和舒张功能的负面影响早在青春期就已出现。这凸显了在生命早期预防肥胖和EAT沉积的重要性。
