Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg August University of Göttingen, Göttingen, Germany.
German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
ESC Heart Fail. 2024 Aug;11(4):2013-2022. doi: 10.1002/ehf2.14744. Epub 2024 Mar 13.
This study aimed to identify the impact of increased epicardial adipose tissue (EAT) and its regional distribution on cardiac function in patients with diastolic dysfunction.
Sixty-eight patients with exertional dyspnoea (New York Heart Association ≥II), preserved ejection fraction (≥50%), and diastolic dysfunction (E/e' ≥ 8) underwent rest and stress right heart catheterization, transthoracic echocardiography, and cardiovascular magnetic resonance (CMR). EAT volumes were depicted from CMR short-axis stacks. First, the impact of increased EAT above the median was investigated. Second, the association of ventricular and atrial EAT with myocardial deformation at rest and during exercise stress was analysed in a multivariable regression analysis. Patients with high EAT had higher HFA-PEFF and H2FPEFF scores as well as N-terminal prohormone of brain natriuretic peptide levels (all P < 0.048). They were diagnosed with manifest heart failure with preserved ejection fraction (HFpEF) more frequently (low EAT: 37% vs. high EAT: 64%; P = 0.029) and had signs of adverse remodelling indicated by higher T1 times (P < 0.001). No differences in biventricular volumetry and left ventricular mass (all P > 0.074) were observed. Patients with high EAT had impaired atrial strain at rest and during exercise stress, and impaired ventricular strain during exercise stress. Regionally increased EAT was independently associated with functional impairment of the adjacent chambers.
Patients with diastolic dysfunction and increased EAT show more pronounced signs of diastolic functional failure and adverse structural remodelling. Despite similar morphological characteristics, patients with high EAT show significant cardiac functional impairment, in particular in the atria. Our results indicate that regionally increased EAT directly induces atrial functional failure, which represents a distinct pathophysiological feature in HFpEF.
本研究旨在探讨心外膜脂肪组织（EAT）增加及其分布对舒张功能障碍患者心功能的影响。
68 例劳力性呼吸困难（纽约心脏协会≥Ⅱ级）、射血分数保留（≥50%）和舒张功能障碍（E/e'≥8）患者接受静息和应激右心导管检查、经胸超声心动图和心血管磁共振（CMR）检查。从 CMR 短轴堆栈中描绘 EAT 体积。首先，研究了 EAT 高于中位数的影响。其次，在多变量回归分析中分析了心室和心房 EAT 与静息和运动应激时心肌变形的关系。高 EAT 患者的 HFA-PEFF 和 H2FPEFF 评分以及 N 末端脑利钠肽前体水平均较高（均 P<0.048）。他们更频繁地被诊断为射血分数保留的心力衰竭（HFpEF）（低 EAT：37% vs. 高 EAT：64%；P=0.029），并且 T1 时间较长表明存在不良重构迹象（P<0.001）。双心室容积和左心室质量无差异（均 P>0.074）。高 EAT 患者在静息和运动应激时心房应变受损，在运动应激时心室应变受损。区域性增加的 EAT 与邻近腔室的功能障碍独立相关。
舒张功能障碍和 EAT 增加的患者表现出更明显的舒张功能衰竭和不良结构重构迹象。尽管形态学特征相似，但高 EAT 患者的心脏功能明显受损，尤其是在心房。我们的结果表明，区域性增加的 EAT 直接导致心房功能衰竭，这是 HFpEF 的一个独特的病理生理特征。
