心外膜脂肪体积与冠状动脉粥样硬化及左心室舒张功能的相关性研究

目的:通过双源64排CT对心外膜脂肪(EAT)进行三维立体重建,并测量其体积,探讨与冠心病发生、病变程度、斑块类型及早期心功能变化的关系。方法:临床疑诊冠心病(CAD)患者131例为研究对象,男性93例,女性38例,平均年龄(56±10)岁,收集所有病例一般临床资料,静脉取血行血脂、血常规及肝肾功能检查。超声心动图明确左心功能情况。所有患者均行冠状动脉64排双源CT血管成像检查,评价冠状动脉内斑块类型及稳定性,应用Vitrea FX(Vital Images)工作站的cardiac fat软件对EAT进行三维重建并测量其体积;根据冠状动脉造影结果确诊冠心病,并评价冠状动脉病变血管支数、病变部位及管腔狭窄程度。结果:冠心病组(n=63)EAT体积明显大于非冠心病组(n=68,P=0.003);冠状动脉3支病变者EAT体积,较1支及2支病变者明显增多(P<0.05);冠状动脉单纯低密度斑块者EAT体积较无斑块和单纯钙化者明显增大(P<0.001)。Pearson相关分析显示:EAT体积与腰围成正相关(r=0.475,P<0.001),与BMI成正相关(r=0.386,P<0.001)。Logistic回归分析显示EAT体积是冠心病的独立危险因素(OR=1.018,95%CI 1.004～1.033,P=0.011)。2组中左心室舒张功能减低者EAT体积均明显增加(P<0.05),EAT体积与左心室舒张末期内径明显正相关(r=0.331,P<0.001),与室间隔厚度正相关(r=0.195,P=0.031)。结论:EAT含量的增多与冠心病的发生、冠状动脉病变支数及易损斑块的形成密切相关,参与了左心室舒张功能的损伤过程,可能是冠心病新的危险因素,将可能是评价心血管疾病风险增加的新的无创指标,及潜在的治疗靶点。

Association of epicardial adipose tissue volume with coronary artery atherosclerosis and left ventricular diastolic function

Objective:To measure epicardial adipose tissue(EAT) volume by the three-dimensional volume-rendering reconstruction technique of dual-source 64 slice computed tomography,and then explore the correlations of ETA volume with the severity of coronary artery atherosclerosis,the coronary artery vulnerable plaques and the diastolic function of left ventricular.Methods:Dual-source 64 slice computed tomography was performed in 131 consecutive patients with suspected coronary artery disease(CAD)(93 males and 38 females).The ages ranged from 37 to 79 years with a mean ± standard deviation(SD) of(56 ± 10) years.For each patient,body mass index(BMI),waist circumference(WC) and blood biochemical parameters were measured.Transthoracic echocardiographic examination was performed to assess the left ventricular diastolic function.EAT volume was determined by cardiac fat software on a workstation(Vitrea FX,Vital Images).Percutaneous coronary angiography was applied to confirm CAD in patients and assess the severity of coronary atherosclerosis.Results:(1) The volume of EAT in patients with CAD(n=63) was higher than that in patients without CAD(n=68)(P=0.003).(2) The volume of EAT was significantly higher in patients with three-vessel lesion(P<0.05).(3) EAT volume was significantly larger in patients with non-calcified plaque compared to that in those with calcified plaque or no plaque(all P<0.001).(4) EAT volume was positively correlated with WC and BMI(r=0.475,P<0.001;r=0.386,P<0.001).After adjusting for confounding risk variables by logistic regression analysis,EAT volume was found as an independent predictor of CAD(odds ratio=1.018,95% confidence interval 1.004～1.033,P=0.011).(5) EAT volume increased in patients with left ventricular diastolic dysfunction(P<0.05).EAT volume was positively correlated with left ventricular internal diameter in diastole(LVIDd) and interventricular septum thickness(IVSDd) respectively(r=0.331,P<0.001;r=0.195,P=0.031).Conclusion: These findings suggested that EAT was associated with the development of coronary artery atherosclerosis and potentially with the vulnerable plaque.EAT may play an important role in the progress of left ventricular diastolic dysfunction.Therefore,EAT may be the new target for investigating the relationship between obesity and the pathogenesis of cardiovascular disease.