Nakamori Shiro, Yazdanian Forough, Ghanbari Fahime, Rodriguez Jennifer, Yue Jennifer, Street Jordan, Kramer Daniel B, Ngo Long H, Manning Warren J, Nezafat Reza
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
JACC Adv. 2024 Dec 26;3(12):101407. doi: 10.1016/j.jacadv.2024.101407. eCollection 2024 Dec.
Risk stratification for sudden cardiac death (SCD) in patients with nonischemic cardiomyopathy (NICM) remains challenging.
This study aimed to investigate the impact of epicardial adipose tissue (EAT) on SCD in NICM patients.
Our study cohort included 173 consecutive patients (age 53 ± 14 years, 73% men) scheduled for primary prevention implantable cardioverter-defibrillators (ICDs) implantation who underwent preimplant cardiovascular magnetic resonance. EAT volume surrounding both ventricles was manually quantified from cine left ventricular short-axis images by summation of the EAT volume of each slice using the modified Simpson rule. The primary endpoint was appropriate ICD therapy.
During the mean follow-up of 3.6 years, 24 patients (14%) experienced an endpoint. An inverse and proportional relationship was evident between EAT and subsequent ICD therapies ( = 0.004). Even after adjusting for left ventricular mass and ejection fraction, EAT was significantly lower in patients with ICD therapy than those without. Low EAT was independently associated with an increased risk of ICD therapy in NICM patients (HR per 10 mL/m decrease, 1.65; 95% CI: 1.17-2.42; = 0.007). EAT ≤50 mL/m demonstrated a 3-fold increase in SCD event risk, with an estimated likelihood of 57% at 5 years. When considered with other potential risk factors, EAT provided incremental prognostic value in predicting ICD therapy.
Low ventricular EAT was associated with increased SCD risk in NICM patients receiving primary prevention ICD implantation, even in the presence of other risk markers. These data suggest a potential clinical role of EAT in selecting NICM patients who would benefit most from ICD implantation.
非缺血性心肌病（NICM）患者心脏性猝死（SCD）的风险分层仍然具有挑战性。
本研究旨在探讨心外膜脂肪组织（EAT）对NICM患者SCD的影响。
我们的研究队列包括173例连续接受一级预防植入式心律转复除颤器（ICD）植入的患者（年龄53±14岁，73%为男性），这些患者在植入前接受了心血管磁共振检查。通过使用改良的辛普森法则对每个层面的EAT体积求和，从 cine 左心室短轴图像手动量化双侧心室周围的EAT体积。主要终点是适当的ICD治疗。
在平均3.6年的随访期间，24例患者（14%）发生了终点事件。EAT与随后的ICD治疗之间存在明显的负相关和比例关系（P = 0.004）。即使在调整左心室质量和射血分数后，接受ICD治疗的患者的EAT仍显著低于未接受治疗的患者。低EAT与NICM患者ICD治疗风险增加独立相关（每减少10 mL/m，HR为1.65；95%CI：1.17 - 2.42；P = 0.007）。EAT≤50 mL/m显示SCD事件风险增加3倍，5年时估计可能性为57%。当与其他潜在风险因素一起考虑时，EAT在预测ICD治疗方面提供了额外的预后价值。
即使存在其他风险标志物，接受一级预防ICD植入的NICM患者中低心室EAT与SCD风险增加相关。这些数据表明EAT在选择最能从ICD植入中获益的NICM患者方面具有潜在的临床作用。
