Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine.
Department of Internal Medicine.
Am J Cardiol. 2023 Nov 15;207:339-348. doi: 10.1016/j.amjcard.2023.08.136. Epub 2023 Sep 27.
Obesity is a predictor of the development of systolic and diastolic heart failure (HF), but once established, patients with HF and obesity have better outcomes than their leaner counterparts, a phenomenon termed the "obesity paradox." We sought to investigate the impact of adipose tissue quantity and distribution, measured by way of computed tomography, on outcomes in patients with HF. Patients admitted for acute decompensated HF between January 2017 to December 2018 were retrospectively analyzed. Body composition measurements were made on computed tomography of the abdomen/pelvis. Visceral, subcutaneous, and intermuscular adipose tissues were measured at the mid-third lumbar vertebra, along with skeletal muscle and waist circumference. Paracardial (pericardial and epicardial) adipose tissue was measured at the mid-eight thoracic vertebra. Visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI), along with skeletal muscle index, were indexed for patient height. A total of 200 patients were included, 44.5% female. Body mass index and waist circumference did not significantly predict outcomes. Patients with high SATI (highest sex-stratified tertile) had significantly better survival (hazard ratio 0.58, 95% confidence interval 0.39 to 0.87, p = 0.009), whereas high VATI was nonsignificant. Patients were further divided into 4 groups based on both VATI and SATI. One- and 4-year mortality risks were lowest in those with low VATI high SATI compared with the other groups; this persisted after multivariable adjustment for covariates, including albumin and skeletal muscle index. In conclusion, the "obesity paradox" appears to be largely driven by subcutaneous adipose tissue, independent of nutrition or skeletal muscle.
肥胖是收缩性和舒张性心力衰竭（HF）发展的预测因素，但是一旦发生，肥胖的 HF 患者比消瘦患者的预后更好，这种现象被称为“肥胖悖论”。我们试图研究通过计算机断层扫描（CT）测量的脂肪组织数量和分布对 HF 患者结局的影响。回顾性分析了 2017 年 1 月至 2018 年 12 月期间因急性失代偿性 HF 入院的患者。在腹部/骨盆 CT 上进行身体成分测量。在第 3 腰椎中段测量内脏、皮下和肌肉间脂肪组织，同时测量骨骼肌和腰围。在心包（心包和心外膜）脂肪组织在第 8 胸椎中段测量。内脏脂肪组织指数（VATI）和皮下脂肪组织指数（SATI），以及骨骼肌指数，都根据患者身高进行了指数化。共纳入 200 例患者，女性占 44.5%。BMI 和腰围不能显著预测结局。SATI 高（最高性别分层三分位数）的患者生存显著更好（风险比 0.58，95%置信区间 0.39 至 0.87，p=0.009），而 VATI 高无显著差异。进一步根据 VATI 和 SATI 将患者分为 4 组。与其他组相比，VATI 低 SATI 高的患者 1 年和 4 年的死亡率风险最低；在对白蛋白和骨骼肌指数等协变量进行多变量调整后，这种情况仍然存在。总之，“肥胖悖论”似乎主要由皮下脂肪组织驱动，与营养或骨骼肌无关。
