Paradoxical Prognostic Implications of Visceral Adiposity for Lethal Cardiac Events in Association with Impaired Cardiac Sympathetic Innervation in Chronic Heart Failure.
Paradoxical Prognostic Implications of Visceral Adiposity for Lethal Cardiac Events in Association with Impaired Cardiac Sympathetic Innervation in Chronic Heart Failure.
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内脏肥胖对致命性心脏事件的矛盾预后影响与慢性心力衰竭心脏交感神经支配受损有关。
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
A. Hashimoto
中科院分区：
文献类型：
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作者：
T. Doi;T. Nakata;Takahiro Noto;T. Mita;Satoshi Yuda;A. Hashimoto
背景资料：肥胖会增加发生心力衰竭（HF）的风险，但肥胖可能与HF患者的更好结局有关。本研究旨在阐明HF患者内脏肥胖与心脏交感神经功能相关的矛盾预后价值。方法和结果：共653例连续的收缩期HF患者，使用计算机断层扫描技术进行内脏脂肪面积（VAA）测量，分为3组：VAA 1，面积<80 cm 2; VAA 2，面积80-140 cm 2; VAA 3，面积>140 cm 2。交感神经支配通过123 I-MIBG心脏活动来量化。患者平均随访22个月，主要终点为致死性心脏事件（CE）。与非CE组相比，CE组（n=200）具有较低的晚期心脏-纵隔比率（HMR）和较小的VAA。总体CE/HF死亡率与VAA呈负相关：VAA 1为39.2% ± 6.2%，VAA 2为27.4% ± 19.9%，VAA 3为24.1% ± 15.3%。除心源性猝死率外，致死性心源性事件发生率也与内脏脂肪肥胖相关：VAA 1为3.0%，VAA 2为7.5%，VAA 3为8.8%。晚期HMR确定了各组中的高风险亚群。结论：内脏肥胖在HF死亡率和致死性心脏病/心源性猝死事件方面具有矛盾的预后意义。心脏交感神经去支配和定量内脏脂肪与总体心脏死亡率协同相关，有助于更好地对HF患者进行风险分层。
Background: Obesity increases the risk for development of heart failure (HF) but, when present is likely to be related to better outcomes in patients with HF. This study aimed to clarify the paradoxical prognostic values of visceral obesity in association with cardiac sympathetic function in HF patients. Methods and Results: A total of 653 consecutive patients with systolic HF who underwent visceral adiposity area (VAA) measurements using a computed tomographic technique were divided into 3 groups: VAA 1, area <80 cm2; VAA 2, area 80-140 cm2; VAA 3, area >140 cm2. Sympathetic innervation was quantified by 123I-MIBG cardiac activity. Patients were followed up for an average of 22 months with a primary endpoint of lethal cardiac events (CE). The CE group (n=200) had a lower late heart-to mediastinum ratio (HMR) and a smaller VAA than those in the non-CE group. Rates of overall CE/HF death were inversely correlated with VAA: 39.2% ± 6.2% for VAA 1, 27.4% ± 19.9% for VAA 2 and 24.1% ± 15.3% for VAA 3. In addition to sudden cardiac death rate, lethal arrhythmic event rate increased in association with visceral fat obesity: 3.0% for VAA 1, 7.5% for VAA 2 and 8.8% for VAA 3. Late HMR identified high-risk sub-populations in each group. Conclusion: Visceral obesity has paradoxical prognostic implications in terms of HF mortality and lethal arrhythmic/sudden cardiac death events. Cardiac sympathetic denervation and quantitative visceral adiposity are synergistically associated with overall cardiac mortality, contributing to better risk stratification of HF patients.