心外膜脂肪容积预测阻塞性冠心病伴心肌缺血的增益价值  

Incremental value of epicardial fat volume on predicting obstructive coronary artery disease with myocardial ischemia

作　　者：俞雯吉 陈勇峻 杨晓宇[2] 王建锋[1] 邵晓梁[1] 张飞飞 刘保 王跃涛[1] Yu Wenji;Chen Yongjun;Yang Xiaoyu;Wang Jianfeng;Shao Xiaoliang;Zhang Feifei;Liu Bao;Wang Yuetao(Department of Nuclear Medicine,the Third Affiliated Hospital of Soochow University,the First People′s Hospital of Changzhou,Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging,Soochow University,Changzhou 213003,China;Department of Cardiology,the Third Affiliated Hospital of Soochow University,the First People′s Hospital of Changzhou,Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院、常州市第一人民医院核医学科、苏州大学核医学与分子影像临床转化研究所,常州213003 [2]苏州大学附属第三医院、常州市第一人民医院心血管内科,常州213003

出　　处：《中华心血管病杂志》2023年第6期633-641,共9页Chinese Journal of Cardiology

基　　金：国家自然科学基金(82272031,81871381);江苏省重点研发计划(社会发展)项目(BE2021638)。

摘　　要：目的探讨心外膜脂肪容积(EFV)与阻塞性冠心病伴心肌缺血的关系,与传统心血管疾病危险因素及冠状动脉钙化(CAC)预测模型比较,评价EFV预测阻塞性冠心病伴心肌缺血的增益价值。方法本研究为回顾性横断面研究。连续入选2018年3月至2019年11月于苏州大学附属第三医院就诊并行冠状动脉造影(CAG)及单光子发射计算机断层扫描-心肌灌注成像(SPECT-MPI)的疑诊冠心病患者。通过胸部非增强计算机断层扫描获得EFV与CAC。阻塞性冠心病定义为1支及以上冠状动脉管腔狭窄≥50%,心肌缺血定义为负荷及静息MPI可逆性灌注缺损,阻塞性冠心病伴心肌缺血定义为冠状动脉造影诊断至少1支冠状动脉狭窄≥50%且至少1支狭窄冠状动脉供血的心肌区域存在心肌缺血。两者均不具备或仅具备其一为无阻塞性冠心病伴心肌缺血。据此将患者分为2组。收集、比较两组的临床资料、CAC及EFV参数。使用多因素logistic回归模型评估EFV和阻塞性冠心病伴心肌缺血的相关性,应用受试者工作特征曲线(ROC)评价EFV能否在传统危险因素及CAC基础上提高对阻塞性冠心病伴心肌缺血的预测。结果共纳入164例疑诊冠心病患者,年龄(61.4±9.9)岁,男性111例,阻塞性冠心病伴心肌缺血患者62例(37.8%),无阻塞性冠心病伴心肌缺血患者102例(62.2%)。阻塞性冠心病伴心肌缺血患者EFV显著高于无阻塞性冠心病伴心肌缺血患者[(135.63±33.29)cm^(3)比(105.18±31.16)cm^(3),P<0.01]。单因素logistic回归分析显示,EFV每增加1个标准差,阻塞性冠心病伴心肌缺血风险增加1.96倍(OR=2.96,95%CI:1.89~4.62,P<0.01)。校正传统心血管疾病危险因素及CAC后,EFV是阻塞性冠心病伴心肌缺血的独立影响因子(OR=4.48,95%CI:2.17~9.23,P<0.01)。在传统心血管疾病危险因素联合CAC预测阻塞性冠心病伴心肌缺血的模型上加入EFV后曲线下面积更大(0.90比0.85,P=0.04),该模型95%CI为0.85~0Objective This study aimed to investigate the association between epicardial fat volume(EFV)and obstructive coronary artery disease(CAD)with myocardial ischemia,and evaluate the incremental value of EFV on top of traditional risk factors and coronary artery calcium(CAC)in predicting obstructive CAD with myocardial ischemia.Methods This study was a retrospective cross-sectional study.Patients with suspected CAD who underwent coronary angiography(CAG)and single photon emission computerized tomography-myocardial perfusion imaging(SPECT-MPI)at the Third Affiliated Hospital of Soochow University from March 2018 to November 2019 were consecutively enrolled.EFV and CAC were measured by non-contrast chest computed tomography(CT)scan.Obstructive CAD was defined as coronary artery stenosis≥50%in at least one of the major epicardial coronary arteries,and myocardial ischemia was defined as reversible perfusion defects in stress and rest MPI.Obstructive CAD with myocardial ischemia was defined in patients with coronary stenosis severity≥50%and reversible perfusion defects in the corresponding areas of SPECT-MPI.Patients with myocardial ischemia bot without obstructive CAD were defined as none-obstructive CAD with myocardial ischemia group.We collected and compared the general clinical data,CAC and EFV between the two groups.Multivariable logistic regression analysis was performed to identify the relationship between EFV and obstructive CAD with myocardial ischemia.ROC curves were performed to determine whether addition of EFV improved predictive value beyond traditional risk factors and CAC for obstructive CAD with myocardial ischemia.Results Among the 164 patients with suspected CAD,111 patients were males,and average age was(61.4±9.9)years old.62(37.8%)patients were included into the obstructive CAD with myocardial ischemia group.102(62.2%)patients were included into the none-obstructive CAD with myocardial ischemia group.EFV was significantly higher in obstructive CAD with myocardial ischemia group than in none-obstru

关 键 词：冠心病 心肌缺血 心外膜脂肪容积 冠状动脉钙化 

分 类 号：R541.4[医药卫生—心血管疾病]