Chang Sheng-Hsiung, Chu Po-Hua, Tsai Cheng-Ting, Kuo Jen-Yuan, Tsai Jui-Peng, Hung Ta-Chuan, Hou Charles Jia-Yin, Lai Yau-Hui, Liu Chia-Yuan, Huang Wei-Ming, Yun Chun-Ho, Yeh Hung-I, Hung Chung-Lieh
Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
Front Cardiovasc Med. 2022 Sep 21;9:939515. doi: 10.3389/fcvm.2022.939515. eCollection 2022.
Epicardial adipose tissue (EAT) as a marker of metabolic disorders has been shown to be closely associated with a variety of unfavorable cardiovascular events and cardiac arrhythmias. Data on regional-specific visceral adiposity outside the heart and its modulation on autonomic dysfunction, particularly heart rate recovery after exercise, remain obscure.
We studied 156 consecutive subjects (mean age: 49.3 ± 8.0 years) who underwent annual health surveys and completed treadmill tests. Multi-detector computed tomography-based visceral adiposity, including EAT and peri-aortic fat (PAF) tissue, was quantified using dedicated software (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA). We further correlated EAT and PAF with blood pressure and heart rate (HR) recovery information from an exercise treadmill test. Metabolic abnormalities were scored by anthropometrics in combination with biochemical data.
Increased EAT and PAF were both associated with a smaller reduction in systolic blood pressure during the hyperventilation stage before exercise compared to supine status (β-coefficient (coef.): -0.19 and -0.23, respectively, both < 0.05). Both visceral adipose tissue mediated an inverted relationship with heart rate recovery at 3 (EAT: β-coef.: -0.3; PAF: β-coef.: -0.36) and 6 min (EAT: β-coef.: -0.32; PAF: β-coef.: -0.34) after peak exercise, even after adjusting for baseline clinical variables and body fat composition (all < 0.05).
Excessive visceral adiposity, whether proximal or distal to the heart, may modulate the autonomic response by lowering the rate of HR recovery from exercise after accounting for clinical metabolic index. Cardiac autonomic dysfunction may partly explain the increase in cardiovascular morbidity and mortality related to both visceral fats.
心外膜脂肪组织（EAT）作为代谢紊乱的一个标志物，已被证明与多种不良心血管事件和心律失常密切相关。关于心脏外区域特异性内脏脂肪及其对自主神经功能障碍的调节作用的数据，尤其是运动后心率恢复情况，仍不明确。
我们研究了156名连续接受年度健康调查并完成跑步机测试的受试者（平均年龄：49.3±8.0岁）。使用专用软件（Aquarius 3D Workstation，TeraRecon，美国加利福尼亚州圣马特奥）对基于多探测器计算机断层扫描的内脏脂肪进行定量，包括EAT和主动脉周围脂肪（PAF）组织。我们进一步将EAT和PAF与运动跑步机测试中的血压和心率（HR）恢复信息进行关联。通过人体测量学结合生化数据对代谢异常进行评分。
与仰卧位相比，运动前过度通气阶段收缩压下降幅度较小与EAT和PAF增加均相关（β系数（coef.）：分别为-0.19和-0.23，均<0.05）。在运动峰值后3分钟（EAT：β系数：-0.3；PAF：β系数：-0.36）和6分钟（EAT：β系数：-0.32；PAF：β系数：-0.34）时，即使在调整基线临床变量和体脂组成后，两种内脏脂肪组织均与心率恢复呈负相关（均<0.05）。
无论心脏近端还是远端，内脏脂肪过多在考虑临床代谢指标后可能通过降低运动后心率恢复率来调节自主神经反应。心脏自主神经功能障碍可能部分解释了与两种内脏脂肪相关的心血管发病率和死亡率的增加。
