Epicardial adipose tissue is a robust measure of increased risk of myocardial infarction - a meta-analysis on over 6600 patients and rationale for the EPIC-ACS study.
Epicardial adipose tissue is a robust measure of increased risk of myocardial infarction - a meta-analysis on over 6600 patients and rationale for the EPIC-ACS study.
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DOI：
10.1097/md.0000000000028060
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发表时间：
2021-12-30
期刊：
影响因子：
1.6
通讯作者：
Mahabadi AA
中科院分区：
文献类型：
--
作者：
Hendricks S;Dykun I;Balcer B;Totzeck M;Rassaf T;Mahabadi AA
心外膜脂肪组织（EAT）围绕心脏和冠状血管。EAT产生促炎和抗炎细胞因子。一些研究已经证明了EAT与心血管危险因素以及冠状动脉疾病表现的相关性。目前，计算机断层扫描（CT）被认为是测量EAT三维体积的金标准。此外，超声心动图可能是一种容易获得的替代方法，特别是在紧急情况下。我们对现有的研究进行了荟萃分析，这些研究描述了心肌梗死患者和非心肌梗死患者EAT的差异。我们使用已建立的数据库，并搜索“心外膜脂肪组织”或“心包脂肪组织”和“心肌梗死”，“冠状动脉事件”或“急性冠状动脉综合征”。我们纳入了来自7项研究的6600多名患者。计算随机效应模型，并使用Review Manager 5.3进行所有分析。与非心肌梗死患者相比，心肌梗死患者的EAT测量值高37%（置信区间[0.21-0.54]，P值<0.001）]。比较使用超声心动图与CT评估EAT厚度的研究，观察到EAT的相似相对差异，置信区间重叠很大（超声心动图：0.4 [0.04-0.76]，CT：0.36 [0.16-0.57]，P值均<0.001）。与非心肌梗死患者相比，心肌梗死患者的EAT更多，与所使用的成像方式无关。需要进一步的前瞻性研究来评估，如何量化EAT在临床常规可以改善患者的管理。
Epicardial adipose tissue (EAT) surrounds the heart and the coronary vessels. EAT produces pro- and anti-inflammatory cytokines. Several studies have already documented the association of EAT and cardiovascular risk factors as well as coronary artery disease manifestations. Currently computed tomography (CT) is considered the gold standard for measurement of 3-dimensional volume of EAT. In addition, echocardiography might be an easy accessible alternative in particular in an emergency setting. We performed a metaanalysis of existing studies describing the differences of EAT in patients with and without myocardial infarction. We used established databases and were searching for “epicardial adipose tissue” or “pericardial adipose tissue” and “myocardial infarction”, “coronary events”, or “acute coronary syndrome”. We included over 6600 patients from 7 studies. Random effect models were calculated and all analyses were performed by using the Review Manager 5.3. Patients with myocardial infarction had 37% (confidence interval [0.21-0.54], P value <.001)] higher measures of EAT compared to patients without myocardial infarction. Comparing studies using echocardiography vs CT for assessment of EAT thickness, similar relative differences in EAT with wide overlap of confidence intervals were observed (for echocardiography: 0.4 [0.04-0.76], for CT: 0.36 [0.16-0.57], P value <.001 for both). Patients with myocardial infarction have more EAT as compared to patients without myocardial infarction independently of the used imaging modality. Further prospective studies are needed to evaluate, how quantification of EAT in clinical routine can improve patients management.