经计算机断层扫描和超声心动图评估的心外膜脂肪组织与不良心血管结局相关：系统评价和荟萃分析。

Epicardial Adipose Tissue Assessed by Computed Tomography and Echocardiography Are Associated With Adverse Cardiovascular Outcomes: A Systematic Review and Meta-Analysis.

机构信息

Yong Loo Lin School of Medicine, National University of Singapore (B.C., J.J., J.R., R.G., Y.H.C., G.K., C.H.N., C.L., S.L., M.D.M., M.Y.C.).

Division of Gastroenterology and Hepatology, Department of Medicine (M.D.M.), National University Hospital, Singapore.

出版信息

Circ Cardiovasc Imaging. 2023 May;16(5):e015159. doi: 10.1161/CIRCIMAGING.122.015159. Epub 2023 May 16.

DOI:10.1161/CIRCIMAGING.122.015159

PMID:37192298

Abstract

BACKGROUND

Epicardial adipose tissue (EAT) has garnered attention as a prognostic and risk stratification factor for cardiovascular disease. This study, via meta-analyses, evaluates the associations between EAT and cardiovascular outcomes stratified across imaging modalities, ethnic groups, and study protocols.

METHODS

Medline and Embase databases were searched without date restriction on May 2022 for articles that examined EAT and cardiovascular outcomes. The inclusion criteria were (1) studies measuring EAT of adult patients at baseline and (2) reporting follow-up data on study outcomes of interest. The primary study outcome was major adverse cardiovascular events. Secondary study outcomes included cardiac death, myocardial infarction, coronary revascularization, and atrial fibrillation.

RESULTS

Twenty-nine articles published between 2012 and 2022, comprising 19 709 patients, were included in our analysis. Increased EAT thickness and volume were associated with higher risks of cardiac death (odds ratio, 2.53 [95% CI, 1.17-5.44]; =0.020; n=4), myocardial infarction (odds ratio, 2.63 [95% CI, 1.39-4.96]; =0.003; n=5), coronary revascularization (odds ratio, 2.99 [95% CI, 1.64-5.44]; <0.001; n=5), and atrial fibrillation (adjusted odds ratio, 4.04 [95% CI, 3.06-5.32]; <0.001; n=3). For 1 unit increment in the continuous measure of EAT, computed tomography volumetric quantification (adjusted hazard ratio, 1.74 [95% CI, 1.42-2.13]; <0.001) and echocardiographic thickness quantification (adjusted hazard ratio, 1.20 [95% CI, 1.09-1.32]; <0.001) conferred an increased risk of major adverse cardiovascular events.

CONCLUSIONS

The utility of EAT as an imaging biomarker for predicting and prognosticating cardiovascular disease is promising, with increased EAT thickness and volume being identified as independent predictors of major adverse cardiovascular events.

REGISTRATION

URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42022338075.

摘要

背景

心外膜脂肪组织（EAT）作为心血管疾病的预后和风险分层因素受到关注。本研究通过荟萃分析评估了 EAT 与心血管结局的关联，这些关联按成像方式、种族群体和研究方案进行分层。

方法

在 2022 年 5 月，无日期限制地在 Medline 和 Embase 数据库中搜索了检查 EAT 和心血管结局的文章。纳入标准为：(1) 研究测量基线时成年患者的 EAT；(2) 报告研究结果的随访数据。主要研究结果是主要不良心血管事件。次要研究结果包括心源性死亡、心肌梗死、冠状动脉血运重建和心房颤动。

结果

共纳入 2012 年至 2022 年期间发表的 29 篇文章，共纳入 19709 名患者。分析显示，EAT 厚度和体积增加与心源性死亡（优势比，2.53 [95%置信区间，1.17-5.44]；=0.020；n=4）、心肌梗死（优势比，2.63 [95%置信区间，1.39-4.96]；=0.003；n=5）、冠状动脉血运重建（优势比，2.99 [95%置信区间，1.64-5.44]；<0.001；n=5）和心房颤动（调整后的优势比，4.04 [95%置信区间，3.06-5.32]；<0.001；n=3）的风险增加相关。对于 EAT 的连续测量单位增加 1 个，计算机断层扫描容积定量（调整后的危险比，1.74 [95%置信区间，1.42-2.13]；<0.001）和超声心动图厚度定量（调整后的危险比，1.20 [95%置信区间，1.09-1.32]；<0.001）均增加了主要不良心血管事件的风险。