Department of Cardiology, University Heart Centre, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.
Centre for Translational and Experimental Cardiology, Schlieren, Switzerland.
ESC Heart Fail. 2023 Dec;10(6):3419-3429. doi: 10.1002/ehf2.14483. Epub 2023 Sep 11.
Epicardial adipose tissue (EAT) is a metabolically highly active tissue modulating numerous pathophysiological processes. The aim of this study was to investigate the association between EAT thickness and endothelial function in patients with heart failure (HF) across the entire ejection fraction spectrum.
A total of 258 patients with HF with an ejection fraction across the entire spectrum [HF with reduced ejection fraction (HFrEF), n = 168, age 60.6 ± 11.2 years; HF with preserved ejection fraction (HFpEF), n = 50, mean age 65.1 ± 11.9 years; HF with mildly reduced ejection fraction (HFmrEF), n = 32, mean age 65 ± 12] were included. EAT was measured with transthoracic echocardiography. Vascular function was assessed with flicker-light-induced vasodilation of retinal arterioles (FIDart%) and flow-mediated dilatation (FMD%) in conduit arteries. Patients with HFrEF have less EAT compared with patients with HFpEF (4.2 ± 2 vs. 5.3 ± 2 mm, respectively, P < 0.001). Interestingly, EAT was significantly associated with impaired microvascular function (FIDart%; r = -0.213, P = 0.012) and FMD% (r = -0.186, P = 0.022), even after multivariate correction for confounding factors (age, body mass index, hypertension, and diabetes; standardized regression coefficient (SRC) = -0.184, P = 0.049 for FIDart% and SRC = -0.178, P = 0.043 for FMD%) in HFrEF but not in HFpEF.
Although less EAT is present in HFrEF than in HFpEF, only in HFrEF EAT is associated with vascular dysfunction. The diverging role of EAT in HF and its switch to a functionally deleterious tissue promoting HF progression provide the rationale to specifically target EAT, in particular in patients with reduced ejection fraction.
心外膜脂肪组织（EAT）是一种代谢活跃的组织，可调节多种病理生理过程。本研究旨在探讨整个射血分数谱中心力衰竭（HF）患者 EAT 厚度与内皮功能之间的关系。
共纳入 258 例 HF 患者，射血分数谱全覆盖[射血分数降低性心力衰竭（HFrEF），n=168，年龄 60.6±11.2 岁；射血分数保留性心力衰竭（HFpEF），n=50，平均年龄 65.1±11.9 岁；射血分数中间值降低性心力衰竭（HFmrEF），n=32，平均年龄 65±12]。采用经胸超声心动图测量 EAT。采用闪烁光诱导视网膜小动脉扩张（FIDart%）和血流介导的血管舒张（FMD%）评估血管功能。与 HFpEF 患者相比，HFrEF 患者的 EAT 较少（分别为 4.2±2mm 和 5.3±2mm，P<0.001）。有趣的是，EAT 与微血管功能障碍显著相关（FIDart%：r=-0.213，P=0.012；FMD%：r=-0.186，P=0.022），即使在多变量校正混杂因素（年龄、体重指数、高血压和糖尿病）后也是如此（对于 FIDart%，标准化回归系数（SRC）=-0.184，P=0.049；对于 FMD%，SRC=-0.178，P=0.043），但在 HFpEF 中则不然。
尽管 HFrEF 中的 EAT 少于 HFpEF，但仅在 HFrEF 中，EAT 与血管功能障碍相关。EAT 在 HF 中的作用分歧及其转变为一种促进 HF 进展的功能有害组织，为专门针对 EAT 提供了依据，特别是在射血分数降低的患者中。
