冠心病患者心外膜脂肪组织厚度与颈动脉弹性的相关性研究

目的分析冠心病患者心外膜脂肪层厚度与颈动脉弹性之间相关性。方法选取164例冠心病患者,分为对照组(单支病变狭窄率小于50%)(n=60)、单支病变组(n=44)、双支病变组(n=35)、三支病变组(n=25)。超声检测各组心外膜脂肪组织厚度(EAT),测量颈动脉内-中膜厚度(IMT),对血管的僵硬度(β)、弹性模量(Ep)、顺应性(AC)和膨大指数(AI)以及脉搏波传导速度(PWV-β)等重要指标进行计算,并比较分析。结果三支病变组的EAT显著大于双支病变组、单支病变组和对照组,双支病变组的EAT显著大于单支病变组和对照组(P均0.05)。随着冠心病病变涉及区域持续扩展,颈动脉β、Ep、PWV-β皆显著增加,但是AC则骤减。EAT与颈动脉各项指标IMT、β、Ep、AC、PWV-β均具有较好相关性(r=0.623、0.564、0.495、-0.567、0.664,P均0.05)。结论 EAT和颈动脉弹性指标均可以作为预测冠心病病变范围的重要方法,两者也具有较好的相关性,值得临床推广应用。     

基于T1 mapping技术对心外膜脂肪组织与肥厚性心肌病左室重构关系的研究

目的 利用T1 mapping技术探究心外膜脂肪组织(epicardial adipose tissue,EAT)对肥厚性心肌病(hypertrophic cardiomyopathy,HCM)左室重构的影响.材料与方法 通过心脏磁共振电影序列、对比增强前、后T1 mapping序列对52例于本院确诊为HCM患者的EAT、心肌细胞外容积比率(extracellular volume fraction,ECV)进行测量,通过ECV衡量左室纤维化水平.将EAT以中位数划分为高、低两组,评估EAT及相关临床因素对左室纤维化的影响,采用线性回归分析对上述具有统计学意义的变量进行共线性诊断,并进一步比较不同EAT值发生梗阻性心肌肥厚的差异.结果 高量EAT患者心肌ECV值高于低量EAT患者(P=0.003),且高量EAT发生梗阻性肥厚者多于低量EAT(P=0.012).男性ECV值高于女性(P=0.047),性别与EAT之间不存在多重共线性(容差≥0.1,VIF≤5),其他临床因素与ECV无显著相关(P>0.05).结论 高量EAT发生梗阻性心肌肥厚者增多,是HCM间质纤维化的独立危险因素.     

心外膜脂肪组织体积与原发性高血压合并冠心病的相关性

目的 探讨心外膜脂肪组织(EAT)体积与原发性高血压(EH)合并冠心病(CHD)的关系,并评价EAT体积对EH合并CHD的致病风险及预测价值。方法 连续入选2014年12月-2017年6月于承德医学院附属医院心内科拟诊为稳定性CHD并行冠状动脉CT血管造影(CCTA)检查的EH患者408例,依据CCTA的结果将诊断CHD的患者设为研究组(n=319),非CHD患者设为对照组(n=89);比较两组临床基线资料及EAT体积的差异;受试者工作特征(ROC)曲线评估EAT体积对EH合并CHD的诊断价值,并确定最佳诊断界值;Logistic回归分析EH合并CHD的危险因素;Spearman相关性分析EAT体积与Gensini评分及冠状动脉钙化积分(CACS)的相关性。结果 研究组EAT体积高于对照组(P<0.05);ROC曲线分析显示,EAT体积诊断EH合并CHD的曲线下面积(AUC)为0.698(P<0.05),当EAT体积取最佳诊断界值为172.5 cm³时,诊断EH合并CHD效能最高,敏感度和特异度分别为42.7%和94.3%;多因素Logistic回归分析显示,EAT体积≥172.5 cm³为EH合并CHD的独立危险因素(P<0.05),相对危险度为10.050(3.459~29.204);Spearman相关性分析显示,EAT体积与Gensini评分及CACS呈正相关(r=0.207、0.235,P<0.05)。结论 CCTA测量EAT体积可作为临床诊断EH合并CHD的无创辅助检查手段;EAT体积与EH患者的Gensini评分及CACS呈正相关,高EAT体积是EH合并CHD的独立危险因素。     

2型糖尿病合并酒精性脂肪肝严重程度与心外膜脂肪组织厚度的相关关系

目的应用超声检测2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者心外膜脂肪组织(EAT)厚度,探讨EAT厚度与NAFLD严重程度的关系。方法选取T2DM患者97例,其中未合并NAFLD者47例(对照组),合并NAFLD者50例。根据脂肪肝二维超声表现将合并NAFLD者分为轻度NAFLD组22例、中度NAFLD组19例及重度NAFLD组9例,测量并比较各组EAT厚度,临床及实验室指标即血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2 h血糖(2hPG)、体质量指数(BMI)、腰围等;应用多重线性回归分析EAT厚度与临床及实验室指标的关系。结果轻度NAFLD组、中度NAFLD组、重度NAFLD组EAT厚度分别为(3.98±0.37)mm、(4.59±0.58)mm、(5.52±0.30)mm,均高于对照组[(3.21±0.35)mm],且中度NAFLD组、重度NAFLD组均高于轻度NAFLD组,重度NAFLD组高于中度NAFLD组,差异均有统计学意义(均P0.05)。轻度NAFLD组、中度NAFLD组、重度NAFLD组TG、HbA1c及BMI均高于对照组,重度NAFLD组TG和HbA1c高于中度NAFLD组及轻度NAFLD组,差异均有统计学意义(均P0.05)。中度NAFLD组、重度NAFLD组腰围均高于对照组,重度NAFLD组高于轻度NAFLD组及中度NAFLD组,差异均有统计学意义(均P0.05)。其余指标组间两两比较差异均无统计学意义。EAT厚度与HbA1c、TG、BMI及腰围均呈正相关(r=0.679、0.649、0.601、0.564,均P0.05)。多重线性回归分析显示,HbA1c、TG、BMI是EAT厚度的独立预测因子。结论 T2DM患者合并NAFLD时,其EAT明显增厚,且EAT随着NAFLD严重程度的增加而增厚;超声检查可以客观地评价T2DM合并NAFLD患者EAT的异常改变,具有重要的临床意义。     

超声测量心外膜脂肪厚度评价利拉鲁肽治疗肥胖型2型糖尿病的疗效

目的应用超声测量心外膜脂肪(EAT)厚度,探讨其在评价利拉鲁肽治疗肥胖型2型糖尿病(T2DM)疗效中的价值。方法纳入36例肥胖型T2DM患者,采取利拉鲁肽单一药物治疗。分别于治疗前和治疗3个月后应用超声测量患者的EAT厚度,同时检测体格指标和空腹血糖、糖化血红蛋白(HbA1c)等实验室指标。分析治疗前后EAT的变化与体格指标的变化之间的关系。结果肥胖型T2DM患者治疗后EAT厚度较治疗前明显降低[(6.42±1.48)mm vs.(9.14±2.39)mm],差异有统计学意义(P0.05);且EAT厚度变化与腰围、臀围及体质量指数变化呈正相关(r=0.878、0.899、0.846,均P0.05)。结论应用超声测量EAT厚度可间接评估利拉鲁肽治疗肥胖型T2DM的疗效。     

超声对心脏心外膜脂肪组织的诊断价值

<正>近年来,糖尿病和冠状动脉粥样硬化性心脏病(以下简称冠心病)的发病率日趋增长,心外膜脂肪组织(EAT)与冠心病、代谢综合征等密切相关。心脏超声检查时,EAT表现为右室前方低-无回声区,容易与心包脂肪组织(PAT)和心包积液相混淆。本组通过常规心脏超声结合高频超声检查对心脏表面EAT进行观察测量,研究其声像图特点,旨在探讨超声对EAT的诊断价值。资料与方法一、临床资料选取2011年1月至2014年6月我院门诊及住院心脏超声     

心外膜脂肪体积与冠状动脉粥样硬化及心肌桥的关系

目的探讨心外膜脂肪(EAT)体积与冠状动脉粥样硬化及心肌桥(MB)之间的关系。方法回顾性分析接受冠状动脉CTA检查的375例患者的影像学资料,其中粥样硬化斑块导致冠状动脉狭窄患者116例(斑块组),单纯MB患者78例(MB组),MB合并动脉粥样硬化斑块患者35例(MB合并斑块组),冠状动脉正常者146例(正常组)。测量并比较4组EAT体积。结果斑块组、MB组、MB合并斑块组、正常组平均EAT体积分别为(110.76±37.17)cm 3、(104.97±36.72)cm 3、(112.02±45.32)cm 3、(91.06±34.27)cm 3,斑块组、MB组、MB合并斑块组均高于正常组(P=0.001、0.031、0.043),斑块组、MB组、MB合并斑块组两两比较差异均无统计学差异(P均>0.05)。结论MB患者EAT体积增大,具有发展为动脉粥样硬化的潜在风险。     

DSCT心外膜脂肪不同方法定量与代谢综合征的相关性

目的应用双源CT测量心外膜脂肪(EAT)体积和厚度,分别评价其与代谢综合征(MS)的相关性。方法回顾性分析接受冠状动脉DSCTA检查的住院患者159例,所有患者均行钙化积分(CACS)扫描,记录患者性别、年龄、体质量指数(BMI)、腰围、血压、血糖、血脂。根据国际糖尿病联盟(IDF)标准,分成非MS组和MS组,在CACS图像上测量EAT体积和厚度,评价EAT体积、厚度与MS的相关性。结果男性MS组EAT体积为(148.77±46.89)cm~3,明显高于非MS组[(103.09±32.12)cm~3](P0.001),而女性MS组EAT体积(123.66±39.01)cm~3与非MS组EAT体积(104.62±43.21)cm~3组间差异无统计学意义(P=0.063);男女MS组平均EAT厚度[(7.38±1.69)cm、(7.37±1.61)cm]与非MS组平均EAT厚度[(6.75±1.68)cm、(6.95±1.68)cm)]组间差异均无统计学意义(P=0.079、P=0.304)。Logistic回归分析显示:校正危险因素后,男性EAT体积是MS的独立危险因素(OR=1.06,P=0.024),而女性EAT体积、男女性平均EAT厚度与MS的发生均无相关性(P=0.317、P=0.403、P=0.426)。结论男性EAT体积与MS发生有关,可作为评估MS风险的一个非创伤性指标。     

肾上腺意外瘤诊治现状

肾上腺意外瘤(adrenal incidentaloma,AI)是指在因非肾上腺疾病进行的影像学检查中偶然发现的肾上腺肿块,直径通常>1 cm。随着影像学技术的不断发展,AI的发病率呈现升高的趋势。其尸检发现率达6%。一旦发现AI,激素相关检查及CT、磁共振成像(MRI)等影像学检查能够确定大部分患者的病因。AI中多数是无功能的良性病变,但部分是具有分泌功能或潜在分泌功能的肿瘤,甚至部分属于恶性病变。AI(尤其是较大的AI)若不     

超声评价2型糖尿病患者合并非酒精性脂肪肝与心外膜脂肪厚度的相关关系

目的:应用超声技术评价2型糖尿病(T2DM) 患者合并非酒精性脂肪肝（NAFLD）与心外膜脂肪组织（EAT）厚度的相关关系。 方法:选取2017年12月至2018年7月在大连医科大学附属第二医院内分泌科住院且合并NAFLD的T2DM患者50例作为NAFLD组,另选取47例不合并NAFLD的T2DM患者作为对照组（A组）。对2组患者行肝脏超声及经胸超声心动图检查,根据肝脏超声二维图像特征将NAFLD组按照脂肪肝严重程度分为轻度（B组）、中度（C组）及重度（D组）,并测量四组EAT厚度进行相关性分析。同时获得血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、糖化血红蛋白(HbAlc)、空腹血糖(FBG)、餐后2h血糖(2hPG)、体质指数(BMI)、腰围等临床及生化指标。 结果: B、C、D组的EAT值均高于A组 (P均<0.05),C、D组均高于B组(P均<0.05),D组高于C组(P<0.05)。Spearman相关分析中提示EAT与NAFLD严重程度（r=0.782, P<0.001）、HbA1c（r=0.679, P<0.001）、TG（r =0.649, P<0.001）、BMI（r=0.601,P<0.05）及腰围（r=0.564,P<0.05）呈正相关。在多重线性回归分析中HbAlc、TG、BMI是EAT的独立预测因子。 结论: T2DM患者合并NAFLD时,其EAT厚度明显增厚,且EAT随着NAFLD严重程度的增加而增加,二者呈正相关关系,因此超声技术可以客观地评价T2DM合并NAFLD患者EAT的异常改变,具有重要的临床意义。     

高频超声测量心外膜脂肪组织厚度与冠心病危险因素的相关性分析

目的 采用高频超声技术探讨冠心病患者心外膜脂肪(EAT)厚度与冠心病危险因素的相关性.方法 84例患者根据冠脉造影结果分为冠脉正常组(28例)、冠心病单支病变组(28例)、冠心病多支病变组(28例),用高频超声分别测量EAT厚度和颈动脉IMT,将EAT厚度与颈动脉IMT等冠心病危险因素进行相关性分析.结果 冠心病单支病...     

Epicardial adipose tissue thickness predicts descending thoracic aorta atherosclerosis shown by multidetector computed tomography

Human epicardial adipose tissue (EAT) is a type of visceral adipose tissue functioning as an endocrine organ by secreting hormones and adipocytokines which have an important role in the atherosclerotic process. In this study, we aimed to assess the relationship between EAT measured by dual source multidetector computed tomography (MDCT) and descending thoracic aorta (DTA) atherosclerosis. A total of 148 patients who underwent MDCT for the evaluation of coronary artery disease were enrolled in this study. Thickness of the EAT was measured on contrast enhanced multiplanar reformat images with parasternal short axis view at basal, mid-ventricular and apical levels and horizontal long axis view. The atherosclerotic plaque was scored from 0 to 4 points by the percentage of the luminal surface at the cross sectional area of proximal, mid and distal segments of descending aorta. Among the study population, 84 (56.8%) were male and age was (mean ± standart deviation) 56.9 ± 11.7 years. In patients with critical coronary atherosclerosis, DTA atherosclerosis had a significant relationship with EAT (P = 0.012). Multivariate linear regression analysis revealed that in addition to critical coronary stenosis, age and total epicardial fat thickness were associated with aortic atherosclerosis (β value, 0.058 and 0.035; t value, 4.74 and 2.28, respectively; P < 0.05) after adjustment for traditional cardiovascular risk factors. In this study we demonstrated that atherosclerotic plaque burden of DTA was associated with the amount of EAT thickness among patients with suspected CAD shown by MDCT. Further large scale prospective studies are needed to address the interaction of EAT as well as the mediators of inflammation and adipocytokines with the development of atherosclerotic plaques in aorta and effects on cardiovascular outcomes.     

Echocardiographic measurements of epicardial adipose tissue and comparative ability to predict adverse cardiovascular outcomes in patients with coronary artery disease

The present study aimed to compare echocardiography measurements of epicardial adipose tissue (EAT) thickness and other risk factors regarding their ability to predict adverse cardiovascular outcomes in patients with coronary artery disease (CAD). Outcomes of 107 patients (86 males, 21 females, mean age 63.6 years old) submitted to diagnostic echocardiography and coronary angiography were prospectively analyzed. EAT (measures over the right ventricle, interventricular groove and complete bulk of EAT) and left ventricle ejection fraction (LVEF) were performed by echocardiography. Coronary complexity was evaluated by Syntax score. Primary endpoints were major adverse cardiovascular events (MACE’s), composite of cardiovascular death, myocardial infarction, unstable angina, intra-stent re-stenosis and episodes of decompensate heart failure requiring hospital attention during a mean follow up of 15.94?±?3.6 months. Mean EAT thickness was 4.6?±?1.9 mm; and correlated with Syntax score and body mass index; negatively correlated with LVEF. Twenty-three cases of MACE's were recorded during follow up, who showed higher EAT. Diagnostic ability of EAT to discriminate MACE's was comparable to LVEF (AUROC?>?0.5); but higher than Syntax score. Quartile comparison of EAT revealed that measurement of the complete bulk of EAT provided a better discrimination range for MACE's, and higher, more significant adjusted risk (cutoff 4.6 mm, RR?=?3.91; 95% CI 1.01–15.08; p?=?0.04) than the other risk factors. We concluded that echocardiographic measurement of EAT showed higher predicting ability for MACE’s than the other markers tested, in patients with CAD. Whether location for echocardiographic measurement of EAT impacts the diagnostic performance of this method deserves further study.     

Association between epicardial adipose tissue and recurrence of atrial fibrillation after ablation: a propensity score-matched analysis

The International Journal of Cardiovascular Imaging - To assess the association between epicardial adipose tissue (EAT) index derived from cardiac computed tomography and atrial fibrillation (AF)...     

Development of a nomogram for predicting the risk of left ventricular diastolic function in subjects with type-2 diabetes mellitus

The International Journal of Cardiovascular Imaging - Left ventricular diastolic dysfunction (LVDD) can be affected by many factors, including epicardial adipose tissue (EAT), obesity and type-2...     

超声测量心外膜脂肪厚度评价利拉鲁肽治疗肥胖型T2DM的疗效

目的 通过超声测量心外膜脂肪（EAT）厚度来评价利拉鲁肽治疗肥胖型2型糖尿病（T2DM）的疗效。方法 纳入36例肥胖T2DM患者,采取利拉鲁肽单一药物治疗。分别于治疗前和治疗3个月后应用超声测量患者的EAT厚度,同时测量体格指标和检测空腹血糖（FBG）、糖化血红蛋白（HbA1c）等生化指标。分析治疗前后EAT的变化与体格指标的变化之间是否相关。结果 患者的EAT厚度在治疗后明显降低（P<0.05）,并且EAT厚度变化与腰围（WC）、臀围（HC）及体质指数（BMI）变化存在正相关。 结论 可以通过超声测量EAT厚度评估利拉鲁肽治疗肥胖型T2DM的效果。     

Epicardial Adipose Tissue Increased in Patients with Newly Diagnosed Subclinical Hypothyroidism

Objective

To investigate whether or not patients with subclinical hypothyroidism (SH) have increased epicardial adipose tissue (EAT).

Subjects and Methods

Sixty-one patients with newly diagnosed SH and without any known cardiovascular disease were enrolled. Twenty-four subjects matched for age, gender and body mass index without any thyroid dysfunctions were included as a control group. The EAT was measured by echocardiography and thyroid functions were assessed by routine blood examination.

Results

Patients with SH had higher EAT values than control subjects (3.6 ± 0.9 vs. 2.8 ± 1.4, p = 0.005). Also, SH patients with thyroid-stimulating hormone (TSH) ≥10 mU/l had higher EAT than those with SH with TSH <10 mU/l and control subjects (p = 0.013). In addition, while there was significant correlation between EAT and TSH (r = 0.31, p = 0.014) in patients with SH, there was no significant relation between EAT and TSH in normal subjects (r = 0.09, p = 0.64).

Conclusions

There was a higher level of EAT in patients with SH compared with normal subjects and a significant correlation between EAT and TSH was found.Key Words: Epicardial fat, Coronary heart disease, Subclinical hypothyroidism     

Pathogenic potential of adipose tissue and metabolic consequences of adipocyte hypertrophy and increased visceral adiposity

When caloric intake exceeds caloric expenditure, the positive caloric balance and storage of energy in adipose tissue often causes adipocyte hypertrophy and visceral adipose tissue accumulation. These pathogenic anatomic abnormalities may incite metabolic and immune responses that promote Type 2 diabetes mellitus, hypertension and dyslipidemia. These are the most common metabolic diseases managed by clinicians and are all major cardiovascular disease risk factors. ‘Disease’ is traditionally characterized as anatomic and physiologic abnormalities of an organ or organ system that contributes to adverse health consequences. Using this definition, pathogenic adipose tissue is no less a disease than diseases of other body organs. This review describes the consequences of pathogenic fat cell hypertrophy and visceral adiposity, emphasizing the mechanistic contributions of genetic and environmental predispositions, adipogenesis, fat storage, free fatty acid metabolism, adipocyte factors and inflammation. Appreciating the full pathogenic potential of adipose tissue requires an integrated perspective, recognizing the importance of ‘cross-talk’ and interactions between adipose tissue and other body systems. Thus, the adverse metabolic consequences that accompany fat cell hypertrophy and visceral adiposity are best viewed as a pathologic partnership between the pathogenic potential adipose tissue and the inherited or acquired limitations and/or impairments of other body organs. A better understanding of the physiological and pathological interplay of pathogenic adipose tissue with other organs and organ systems may assist in developing better strategies in treating metabolic disease and reducing cardiovascular disease risk.     

Pathogenic potential of adipose tissue and metabolic consequences of adipocyte hypertrophy and increased visceral adiposity

When caloric intake exceeds caloric expenditure, the positive caloric balance and storage of energy in adipose tissue often causes adipocyte hypertrophy and visceral adipose tissue accumulation. These pathogenic anatomic abnormalities may incite metabolic and immune responses that promote Type 2 diabetes mellitus, hypertension and dyslipidemia. These are the most common metabolic diseases managed by clinicians and are all major cardiovascular disease risk factors. 'Disease' is traditionally characterized as anatomic and physiologic abnormalities of an organ or organ system that contributes to adverse health consequences. Using this definition, pathogenic adipose tissue is no less a disease than diseases of other body organs. This review describes the consequences of pathogenic fat cell hypertrophy and visceral adiposity, emphasizing the mechanistic contributions of genetic and environmental predispositions, adipogenesis, fat storage, free fatty acid metabolism, adipocyte factors and inflammation. Appreciating the full pathogenic potential of adipose tissue requires an integrated perspective, recognizing the importance of 'cross-talk' and interactions between adipose tissue and other body systems. Thus, the adverse metabolic consequences that accompany fat cell hypertrophy and visceral adiposity are best viewed as a pathologic partnership between the pathogenic potential adipose tissue and the inherited or acquired limitations and/or impairments of other body organs. A better understanding of the physiological and pathological interplay of pathogenic adipose tissue with other organs and organ systems may assist in developing better strategies in treating metabolic disease and reducing cardiovascular disease risk.     

超声测量心外膜脂肪组织厚度与冠状动脉病变的相关性研究

目的 评价经超声测量的心外膜脂肪组织厚度(EAT)和冠状动脉病变的相关性.方法 147例接受冠状动脉造影患者,根据造影结果分为冠心病组101例,非冠心病组46例;超声测量EAT,对各组之间的EAT值进行比较,观察EAT与冠心病之间的关系.结果 冠心病组与非冠心病组EAT值分别为(7.41±1.63)mm和(4.41±1.60)mm,冠心病组的EAT值显著升高(P＜0.01).严重冠状动脉病变组EAT较轻度冠状动脉病变组EAT明显升高[(8.53±1.00)mm对(6.36±1.73)mm,P＜0.01].冠状动脉Gensini评分与EAT呈正相关(r=0.71,P＜0.001).以EAT值≥5.35 mm预测冠心病的敏感性为87.13%,特异件为80.43%,ROC曲线下面积为0.89(95%可信区间0.84-0.95,P=0.01).结论 超声测量心外膜脂肪组织厚度简易无创,可能是一个评价冠心病风险的辅助指标,和冠状动脉病变严重程度显著相关.