Epicardial adipose tissue parameters for predicting coronary atherosclerotic heart disease and the degree of coronary artery stenosis in HIV infected patients北大核心CSCD

目的观察以心外膜脂肪组织(EAT)各参数预测HIV感染者冠状动脉粥样硬化性心脏病(CHD)及冠状动脉狭窄程度的价值。方法将149例HIV感染者根据存在CHD与否分为CHD组(n=97)与非CHD组(n=52),再根据冠状动脉狭窄程度将CHD组分为轻度(n=60)、中度(n=23)及重度狭窄亚组(n=14);选取52名非HIV、非CHD志愿者作为对照组。计算各组及亚组冠状动脉左前降支(LAD)、左回旋支(LCX)及右冠状动脉(RCA)周围脂肪衰减指数(FAI)、EAT体积和EAT密度;观察上述各参数预测HIV感染者CHD及冠状动脉狭窄程度的效能。结果CHD组中,各亚组RCA、LAD和LCX周围FAI差异均有统计学意义(P均<0.05),重度狭窄亚组FAI明显高于轻度狭窄亚组(P<0.05)。非CHD组RCA、LAD和LCX周围FAI均明显高于对照组(P均<0.05)。以-87.74 HU为RCA周围FAI的截断值,其预测冠状动脉重度狭窄的敏感度为83.30%,特异度为63.00%,曲线下面积(AUC)为0.75;以-72.29 HU为LAD周围FAI的截断值,其预测冠状动脉重度狭窄的敏感度为75.00%,特异度为80.20%,AUC为0.95;二者AUC差异有统计学意义(Z=2.86,P<0.01)。结论冠状动脉周围FAI可用于评估冠状动脉狭窄程度,尤以LAD周围FAI的价值最高。

Epicardial adipose tissue parameters for predicting coronary atherosclerotic heart disease and the degree of coronary artery stenosis in HIV infected patients

Objective To observe the value of epicardial adipose tissue (EAT) parameters for predicting coronary atherosclerotic heart disease (CHD) and the degree of coronary artery stenosis in HIV infected patients.Methods Totally 149 HIV-infected patients were enrolled and divided into CHD group (n=97) and non CHD group (n=52) according to the existence of CHD. Patients in CHD group were further divided into mild (n=60), moderate (n=23) and severe stenosis subgroup (n=14) according to the degree of coronary artery stenosis. And 52 volunteers without HIV nor CHD were taken as controls (control group). Then pericoronary fat attenuation index (FAI) of left ascending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA), the volume and density of EAT of groups and subgroups were calculated, and the efficiency of EAT parameters for predicting CHD and the degree of coronary artery stenosis in HIV infected patients were analyzed.Results Pericoronary FAI of RCA, LAD and LCX were significantly higher in non CHD group than in control group (all P < 0.05). There were significant differences of pericoronary FAI of RCA, LAD and LCX among 3 subgroups in CHD group (all P < 0.05), while pericoronary FAI in severe stenosis subgroup was significantly higher than that in mild stenosis subgroup (P < 0.05). Taken -87.74 HU as the cutoff value of pericoronary FAI of RCA for predicting severe coronary stenosis, the sensitivity was 83.30%, the specificity was 63.00%, and the area under the curve (AUC) was 0.75. Taken -72.29 HU as the cutoff value of pericoronary FAI of LAD, the sensitivity was 75.00%, the specificity was 80.20%, and AUC was 0.95. There was significant difference of AUC between pericoronary FAI of RCA and LAD (Z=2.86, P < 0.01).Conclusion Pericoronary FAI could be used to predict potential risk factors of CHD in HIV infected patients and evaluate the degree of coronary artery stenosis. Pericoronary FAI of LAD had the highest value.