Baglar Private Hospital, Department of Cardiology - Diyarbakir, Turkey.
Dicle University, School of Medicine, Department of Cardiology - Diyarbakir, Turkey.
Rev Assoc Med Bras (1992). 2022 Sep;68(9):1178-1184. doi: 10.1590/1806-9282.20220069.
Epicardial adipose tissue is a special form of visceral fat surrounding the heart. It is associated with cardiac and metabolic diseases. Epicardial adipose tissue is associated with risk factors for heart failure with preserved ejection fraction, such as obesity, metabolic syndrome, hypertension, and diabetes. In this study, we examined the importance of Epicardial adipose tissue as a predictor of heart failure with preserved ejection fraction.
Patients who were admitted to the Dicle University Medicine Faculty Heart Hospital between November 2013 and August 2014 were recruited for the study. The heart failure group consisted of 30 patients who were admitted to the cardiac intensive care unit, and the control group consisted of 30 patients who were admitted to cardiology polyclinics. We care about patients' demographic and clinical features to be similar. Heart failure was diagnosed according to the European Cardiology Society 2012 heart failure guidelines. Epicardial adipose tissue was measured with a transthoracic parasternal long axis with an echocardiography device (GE Vivid S6). We compared the Epicardial adipose tissue measurements between the two groups.
Epicardial adipose tissue was higher in patients with heart failure with preserved ejection fraction than in the control group (9.21±0.82 and 7.13±1.39 mm, respectively; p<0.001). Echocardiographic findings associated with left ventricular hypertrophy were intact ventricular septum (13.03±0.57 and 12.11±2.22 mm, respectively; p=0.013) and left ventricular mass index (131.13±18.00 and 117.90±20.30 g/m2, respectively; p=0.010). Findings associated with left ventricular diastolic dysfunction were as follows: left atrial volume index (60.71±21.53 and 44.92±9.93 mL/m2, respectively; p<0.001) and E/è (13.87±3.88 and 10.12±2.44, respectively; p<0.001) were higher in patients with heart failure with preserved ejection fraction than in the control group. Body mass index was not a significant indicator of obesity (p=0.097), but waist circumference was a significant indicator of visceral obesity (p<0.001). Logistic regression analyses indicated that Epicardial adipose tissue, age, left atrial volume index, left ventricular mass index, waist circumference, and E/é were significant in the Heart failure group; Epicardial adipose tissue was significant (p=0.012), and waist circumference significance was borderline (p=0.045).
Epicardial adipose tissue was higher in patients with HF than in the control group, and Epicardial adipose tissue was a predictor of heart failure with preserved ejection fraction. In patients with heart failure with preserved ejection fraction, increased Epicardial adipose tissue means that Epicardial adipose tissue can be used as a biomarker of inflammation in the pathophysiology of heart failure with preserved ejection fraction.
心外膜脂肪组织是一种特殊的内脏脂肪，环绕在心脏周围。它与心脏和代谢疾病有关。心外膜脂肪组织与射血分数保留型心力衰竭的危险因素有关，如肥胖、代谢综合征、高血压和糖尿病。在这项研究中，我们研究了心外膜脂肪组织作为射血分数保留型心力衰竭预测因子的重要性。
本研究招募了 2013 年 11 月至 2014 年 8 月期间在迪亚巴克尔大学医学系附属医院住院的患者。心力衰竭组由 30 名入住心内科重症监护病房的患者组成，对照组由 30 名入住心内科门诊的患者组成。我们关注患者的人口统计学和临床特征相似。心力衰竭根据 2012 年欧洲心脏病学会心力衰竭指南进行诊断。心外膜脂肪组织通过经胸胸骨旁长轴超声心动图设备（GE Vivid S6）进行测量。我们比较了两组之间的心外膜脂肪组织测量值。
射血分数保留型心力衰竭患者的心外膜脂肪组织高于对照组（分别为 9.21±0.82 和 7.13±1.39mm；p<0.001）。与左心室肥厚相关的超声心动图发现包括完整的室间隔（分别为 13.03±0.57 和 12.11±2.22mm；p=0.013）和左心室质量指数（分别为 131.13±18.00 和 117.90±20.30g/m2；p=0.010）。与左心室舒张功能障碍相关的发现包括：左心房容积指数（分别为 60.71±21.53 和 44.92±9.93mL/m2；p<0.001）和 E/é（分别为 13.87±3.88 和 10.12±2.44；p<0.001）均高于对照组。体重指数不是肥胖的显著指标（p=0.097），但腰围是内脏肥胖的显著指标（p<0.001）。逻辑回归分析表明，心外膜脂肪组织、年龄、左心房容积指数、左心室质量指数、腰围和 E/é 在心力衰竭组中具有显著意义；心外膜脂肪组织具有显著意义（p=0.012），腰围的意义接近显著（p=0.045）。
射血分数保留型心力衰竭患者的心外膜脂肪组织高于对照组，心外膜脂肪组织是射血分数保留型心力衰竭的预测因子。在射血分数保留型心力衰竭患者中，心外膜脂肪组织的增加意味着心外膜脂肪组织可作为射血分数保留型心力衰竭病理生理学中炎症的生物标志物。
