使用冠状动脉计算机断层扫描血管造影术评估心外膜和冠状动脉周围脂肪组织在射血分数保留的心力衰竭中的预后价值。

The prognostic value of epicardial and pericoronary adipose tissue in heart failure with preserved ejection fraction using coronary computed tomography angiography.

作者信息

Lin Shuangxiang, Liu Chenjia, Wang Shuyue, Ding Xingfa, Wu Jiaxing, Wang Xinhong, Jianzhong Sun

机构信息

The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China.

Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China.

出版信息

Br J Radiol. 2025 Feb 1;98(1166):229-236. doi: 10.1093/bjr/tqae216.

DOI:10.1093/bjr/tqae216

PMID:39454024

Abstract

OBJECTIVES

To assess the prognostic significance of epicardial adipose tissue volume (EATv) and pericoronary adipose tissue attenuation (PCATa) in patients with heart failure with preserved ejection fraction (HFpEF).

METHODS

This retrospective study was based on HFpEF and controls who underwent coronary CT angiography (CCTA) screening to rule out coronary disease. Comparisons of EATv and PCATa were made between HFpEF patients and a control group, using statistical analyses including Kaplan-Meier and Cox regression to assess prognostic significance.

RESULTS

A total of 224 patients were retrospectively analysed. The EATv was 56.1 ± 11.9 cm3 and PCATa in the right coronary artery (PCATa-RCA) was -74.7 HU ± 3.82 in HFpEF patients, which increased significantly compared with controls. Among them, 112 HFpEF patients (mean age: 71.9 ± 8.5 years; 40% male) were followed up for a median of 27 ± 0.6 months (range 2-47 months). EATv and PCATa-RCA were predictive of outcome with an optimal threshold of 56.29 cm3 and -71.17 HU, respectively. In Kaplan-Meier analysis, the high EATv and PCATa-RCA attenuation had significantly higher rates of composite outcomes (log-rank test, all P < .01). EATv and PCATa-RCA were independently predictive of outcome following adjustment for confounding variables (EATv: hazard ratio [HR] 1.03; 95% CI (1.01-1.06); P < .01, PCTAa-RCA: HR 1.44; 95% CI 1.27-1.62; P < .001)).

CONCLUSIONS

Increased EATv and PCATa-RCA are associated with worse clinical outcomes in HFpEF patients.

ADVANCES IN KNOWLEDGE

This study highlights the potential of CCTA-derived adipose tissue metrics as novel, non-invasive biomarkers for risk stratification in HFpEF.

摘要

目的

评估心外膜脂肪组织体积（EATv）和冠状动脉周围脂肪组织衰减（PCATa）在射血分数保留的心力衰竭（HFpEF）患者中的预后意义。

方法

这项回顾性研究基于接受冠状动脉CT血管造影（CCTA）筛查以排除冠心病的HFpEF患者和对照组。在HFpEF患者和对照组之间对EATv和PCATa进行比较，使用包括Kaplan-Meier和Cox回归在内的统计分析来评估预后意义。

结果

共回顾性分析了224例患者。HFpEF患者的EATv为56.1±11.9 cm³，右冠状动脉的PCATa（PCATa-RCA）为-74.7 HU±3.82，与对照组相比显著增加。其中，112例HFpEF患者（平均年龄：71.9±8.5岁；40%为男性）接受了中位时间为27±0.6个月（范围2-47个月）的随访。EATv和PCATa-RCA分别以56.29 cm³和-71.17 HU的最佳阈值预测预后。在Kaplan-Meier分析中，高EATv和PCATa-RCA衰减的复合结局发生率显著更高（对数秩检验，所有P<.01）。在对混杂变量进行调整后，EATv和PCATa-RCA独立预测预后（EATv：风险比[HR]1.03；95%CI（1.01-1.06）；P<.01，PCATa-RCA：HR 1.44；95%CI 1.27-1.62；P<.001）。