类风湿关节炎患者的心外膜脂肪组织体积与心房颤动之间的关系。
Relationship between epicardial adipose tissue volume and atrial fibrillation in patients with rheumatoid arthritis.
作者信息
Yao Hao, Chen Jian, Li Xueling, Zhang Xin
机构信息
Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
出版信息
Front Cardiovasc Med. 2025 Apr 9;12:1508025. doi: 10.3389/fcvm.2025.1508025. eCollection 2025.
INTRODUCTION
Epicardial adipose tissue (EAT) is involved in cardiac inflammatory responses and has been associated with both atrial fibrillation (AF) and rheumatoid arthritis (RA). However, the condition of EAT in patients with both RA and AF is still unclear. In addition, the risks of stroke and bleeding in patients with both RA and AF are unknown.
METHODS
A retrospective analysis was conducted in patients with RA aged ≥18 years from August 2021 to May 2023, and compared with age- and gender-matched patients without RA. The volume of EAT was measured using chest computed tomography and the EAT/body mass index (BMI) ratio was used to correct for the possible impact of BMI differences. The stroke and bleeding risks of the patients were assessed using the CHADS-VASc or HAS-BLED scores.
RESULTS
A total of 145 patients with RA and 282 patients without RA were included. The volume of EAT or EAT/BMI ratio was similar between the patients with RA and no AF and those without both RA and AF. Compared to the patients without AF, those with AF had a larger EAT volume or EAT/BMI ratio, regardless of whether they had RA or not. EAT/BMI ratio was significantly associated with left atrial (LA) diameter among the patients with RA (RR = 2.23, < 0.001) but not among the patients without RA ( < 0.954). The RA groups had larger LA-EAT volume (31.53 ± 11.02 mm vs. 22.56 ± 9.58 mm, < 0.001) and LA-EAT/Total EAT ratio (23.02% ± 3.62% vs. 18.74 ± 3.38 mm, < 0.001) than that in non-RA groups. In addition, the proportion of patients with high stroke risk scores was higher among the patients with both RA and AF compared to those without RA but with AF (90.90% vs. 72.00% in men; 84.78% vs. 71.11% in women), while the proportion of patients with high bleeding risk scores was lower (22.06% vs. 27.85%).
CONCLUSION
LA diameter correlates with the EAT/BMI ratio in patients with RA who exhibit larger LA-EAT volume and LA-EAT/total EAT ratios compared to individuals without RA.
引言
心外膜脂肪组织（EAT）参与心脏炎症反应，并且与心房颤动（AF）和类风湿关节炎（RA）均有关联。然而，RA合并AF患者的心外膜脂肪组织状况仍不明确。此外，RA合并AF患者的中风和出血风险尚不清楚。
方法
对2021年8月至2023年5月年龄≥18岁的RA患者进行回顾性分析，并与年龄和性别匹配的非RA患者进行比较。使用胸部计算机断层扫描测量EAT体积，并使用EAT/体重指数（BMI）比值来校正BMI差异可能产生的影响。使用CHADS-VASc或HAS-BLED评分评估患者的中风和出血风险。
结果
共纳入145例RA患者和282例非RA患者。RA且无AF的患者与既无RA也无AF的患者之间的EAT体积或EAT/BMI比值相似。与无AF的患者相比，有AF的患者，无论是否患有RA，其EAT体积或EAT/BMI比值均更大。在RA患者中，EAT/BMI比值与左心房（LA）直径显著相关（RR = 2.23，<0.001），而在非RA患者中则无此相关性（<0.954）。RA组的LA-EAT体积（31.53±11.02mm vs. 22.56±9.58mm，<0.001）和LA-EAT/总EAT比值（23.02%±3.62% vs. 18.74±3.38mm，<0.001）均高于非RA组。此外，与无RA但有AF的患者相比，RA合并AF患者中中风风险评分高的患者比例更高（男性为90.90% vs. 72.00%；女性为84.78% vs. 71.11%），而出血风险评分高的患者比例更低（22.06% vs. 27.85%）。
结论
与无RA的个体相比，RA患者的LA直径与EAT/BMI比值相关，且RA患者表现出更大的LA-EAT体积和LA-EAT/总EAT比值。
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