心外膜脂肪组织增加与扩张型心肌病患者左心室逆向重构有关。
Increased epicardial adipose tissue is associated with left ventricular reverse remodeling in dilated cardiomyopathy.
作者信息
Xu Yuanwei, Guo Jiajun, Li Yangjie, Wang Shiqian, Wan Ke, Li Weihao, Wang Jie, Xu Ziqian, Cheng Wei, Sun Jiayu, Zhang Qing, Han Yuchi, Chen Yucheng
机构信息
Department of Cardiology, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
West China Clinical Medical College of Sichuan University, Chengdu, China.
出版信息
Cardiovasc Diabetol. 2024 Dec 18;23(1):447. doi: 10.1186/s12933-024-02517-3.
BACKGROUND
Epicardial adipose tissue (EAT) has been suggested to play paradoxical roles in patients with heart failure. The role of EAT in dilated cardiomyopathy (DCM) patients remains unclear. We aimed to assess the associations between the dynamic changes EAT and left ventricular reverse remodeling (LVRR) in DCM patients based on baseline and follow-up CMR.
METHODS
In this prospective study, we consecutive enrolled DCM patients with baseline and follow-up cardiac magnetic resonance (CMR) examinations. All participating patients underwent 1-2 years of guideline-directed medical therapy (GDMT) at follow-up. The EAT was measured as pericardial and epicardial fat thickness, and paracardial fat volume, while the abdominal adiposity was measured in terms of subcutaneous and visceral fat thickness. The univariable and multivariable logistic regression analyses were performed to evaluate the associations of changes in abdominal and epicardial adiposities with the presence of LVRR.
RESULTS
A total of 232 patients (mean age, 45.7 ± 15.1 years, 157 male) at baseline were enrolled. After a period of GDMT with a median duration of 15.5 months (interquartile range, 12.5-19.1 months) all participants underwent follow-up CMR with the same standardized protocol. Patients who reached LVRR showed a significant increment in EAT parameters compared to those who did not. After adjusting for age, sex, and delta changes of body mass index (BMI), the increment of pericardial fat thickness (odds ratio [OR]: 1.53; 95% confidence interval [CI]: 1.27 to 1.83; p < 0.001), epicardial fat thickness (OR: 2.10; 95% CI: 1.68 to 2.63; p < 0.001), and paracardial fat volume (OR: 1.01; 95% CI: 1.01 to 1.02; p = 0.001) were significantly associated with LVRR.
CONCLUSIONS
In DCM patients, the CMR-derived EAT parameters increased after 1-2 years of GDMT and significantly correlated with improved ventricular structure and function, independent of changes in BMI and abdominal adiposity, which may indicate the potential protective role of EAT in DCM patients.
TRIAL REGISTRATION
URL: https://www.
CLINICALTRIALS
gov ; Unique identifier: ChiCTR1800017058.
背景
已有研究表明，心外膜脂肪组织（EAT）在心力衰竭患者中发挥着矛盾的作用。EAT在扩张型心肌病（DCM）患者中的作用仍不清楚。我们旨在基于基线和随访心脏磁共振成像（CMR）评估DCM患者EAT的动态变化与左心室逆向重构（LVRR）之间的关联。
方法
在这项前瞻性研究中，我们连续纳入了接受基线和随访心脏磁共振检查的DCM患者。所有参与患者在随访时均接受了1 - 2年的指南导向药物治疗（GDMT）。EAT通过心包和心外膜脂肪厚度以及心包旁脂肪体积来测量，而腹部肥胖则通过皮下和内脏脂肪厚度来衡量。进行单变量和多变量逻辑回归分析，以评估腹部和心外膜脂肪量变化与LVRR存在之间的关联。
结果
共纳入232例基线患者（平均年龄45.7±15.1岁，男性157例）。在中位持续时间为15.5个月（四分位间距为12.5 - 19.1个月）的GDMT治疗后，所有参与者均按照相同的标准化方案接受了随访CMR检查。与未达到LVRR的患者相比，达到LVRR的患者EAT参数显著增加。在调整年龄、性别和体重指数（BMI）的变化后，心包脂肪厚度的增加（比值比[OR]：1.53；95%置信区间[CI]：1.27至1.83；p < 0.001）、心外膜脂肪厚度（OR：2.10；95% CI：1.68至2.63；p < 0.001）和心包旁脂肪体积（OR：1.01；95% CI：1.01至1.02；p = 0.001）与LVRR显著相关。
结论
在DCM患者中，经过1 - 2年的GDMT治疗后，CMR衍生的EAT参数增加，且与心室结构和功能的改善显著相关，独立于BMI和腹部肥胖的变化，这可能表明EAT在DCM患者中具有潜在的保护作用。
试验注册
网址：https://www.
临床试验
gov；唯一标识符：ChiCTR1800017058。
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