Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure
Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure
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DOI：
10.1002/ejhf.2337
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发表时间：
2021-09-05
影响因子：
18.2
通讯作者：
Masi, Stefano
中科院分区：
文献类型：
--
作者：
Pugliese, Nicola R.;Paneni, Francesco;Masi, Stefano
目的应用心肺-超声联合运动负荷评价超声心外膜脂肪组织(EAT)对心力衰竭(HF)患者心血管血流动力学、代谢及预后的影响。方法与结果分析了射血分数降低(HFrEF，n=205)和保留(HFpEF，n=188)的心力衰竭(HF)患者(包括44例对照组)的EAT厚度。HFpEF患者的EAT值最高，而HFrEF患者的EAT值低于对照组。在HFrEF中，EAT与利钠肽、肌钙蛋白T和C反应蛋白呈负相关，而在HFpEF中与肌钙蛋白T和C反应蛋白呈正相关。EAT与峰值氧耗量(VO2)和外周提取(AVO(2)diff)独立相关，与体重指数无关。在HFpEF中，EAT与峰值VO2和AVO(2)diff呈负相关，而在HFrEF中，EAT与峰值VO2和AVO(2)diff呈正相关，在HFrEF中，较低的EAT值与更严重的左心室收缩功能障碍相关。在HFpEF中，EAT的增加与右室-动脉(三尖瓣环平面收缩运动/肺动脉收缩压)解偶联有关。经过21个月的随访，在心力衰竭人群中有146例心力衰竭住院和34例心血管死亡。COX多变量分析支持EAT在HF队列中的独立差异作用(交互作用P=0.01)：HFpEF组增加EAT[危险比(HR)1.12，95%可信区间(CI)1.04~1.37]和HFrEF组减少EAT(HR 0.75，95%CI 0.54~0.91)的不良事件风险较高。相反，较低的EAT值意味着较高的左心功能不全、整体功能损害和不良预后。
Aims We evaluated the impact of echocardiographic epicardial adipose tissue (EAT) on cardiovascular haemodynamics, metabolic profile and prognosis in heart failure (HF) using combined cardiopulmonary-echocardiography exercise stress.Methods and results We analysed EAT thickness of HF patients with reduced (HFrEF, n = 205) and preserved (HFpEF, n = 188) ejection fraction, including 44 controls. HFpEF patients displayed the highest EAT, while HFrEF patients had lower values than controls. EAT showed an inverse correlation with natriuretic peptides, troponin T and C-reactive protein in HFrEF, while having a direct association with troponin T and C-reactive protein in HFpEF. EAT was independently associated with peak oxygen consumption (VO2) and peripheral extraction (AVO(2)diff), regardless of body mass index. EAT was inversely correlated with peak VO2 and AVO(2)diff in HFpEF, while a direct association was observed in HFrEF, where lower EAT values were associated with worse left ventricular systolic dysfunction. In HFpEF, increased EAT was related to right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) uncoupling. After 21 months of follow-up, 146 HF hospitalizations and 34 cardiovascular deaths were recorded in the HF population. Coxmultivariable analysis supported an independent differential role of EAT in HF cohorts (interaction P = 0.01): higher risk of adverse events for increasing EAT in HFpEF [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.37] and for decreasing EAT in HFrEF (HR 0.75, 95% CI 0.54-0.91).Conclusion In HFpEF, EAT accumulation is associated with worse haemodynamic and metabolic profile, also affecting survival. Conversely, lower EAT values imply higher left ventricular dysfunction, global functional impairment and adverse prognosis in HFrEF.