射血分数降低的心力衰竭患者心外膜脂肪组织与左心室重构和心肌纤维化的相关性分析  

Correlation Analysis Between Epicardial Adipose Tissue and Left Ventricular Remodeling and Myocardial Fibrosis in Patients With Heart Failure With Reduced Ejection Fraction

作　　者：朱庆烨 文娣娣 郑敏文 ZHU Qingye;WEN Didi;ZHENG Minwen(Department of Radiology,Yan'an Medical College of Yan'an University,Yan'an 716000,China;Department of Radiology,The First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]延安大学延安医学院放射影像系,延安716000 [2]中国人民解放军空军军医大学第一附属医院放射科,西安710032

出　　处：《中国循环杂志》2025年第3期227-233,共7页Chinese Circulation Journal

基　　金：国家自然科学基金青年项目(82202149)。

摘　　要：目的:探讨射血分数降低的心力衰竭(HFrEF)患者心外膜脂肪组织(EAT)[包括冠状动脉周围脂肪组织(PCAT)]与左心室重构及心肌纤维化的相关性。方法:回顾性连续纳入2021年5月至2024年1月期间在中国人民解放军空军军医大学第一附属医院确诊为HFrEF且行冠状动脉计算机断层扫描血管成像(CCTA)和心脏磁共振成像(CMR)检查的患者34例,基于CCTA图像测量患者的EAT CT值、体积以及左前降支(LAD)和右冠状动脉(RCA)的PCAT CT值,同时基于CMR图像评估患者的左心室功能参数、心肌钆延迟增强(LGE)和细胞外容积(ECV)。采用Spearman系数分析HFrEF患者中EAT、PCAT与左心室重构及心肌纤维化的相关性。结果:Spearman相关性分析显示,EAT体积与左心室舒张末期容积(LVEDV)、左心室每搏输出量(LVSV)、LGE均呈正相关(P均<0.05)。EAT CT值与LVEDV和左心室收缩末期容积(LVESV)均呈正相关,与左心室重构指数(LVRI)、左心室射血分数(LVEF)、左心室心输出量(LVCO)、LGE均呈负相关(P均<0.05)。LAD的PCAT CT值与LVESV呈正相关,与左心室室壁最大厚度、LVSV、LVEF、LVCO、LGE均呈负相关(P均<0.05)。RCA的PCAT CT值与LVEDV和LVESV均呈正相关,与LVEF和LGE均呈负相关(P均<0.05)。EAT CT值和体积以及PCAT CT值与ECV均无显著相关性(P均>0.05)。结论:在HFrEF患者中,EAT和PCAT均与左心室重构及心肌纤维化有关。Objectives:To investigate the relationship between epicardial adipose tissue(EAT)(including pericoronary adipose tissue[PCAT])with left ventricular remodeling and myocardial fibrosis in heart failure with reduced ejection fraction(HFrEF)patients.Methods:Consecutive patients diagnosed with HFrEF who underwent coronary computed tomography angiography(CCTA)and cardiac magnetic resonance imaging(CMR)examination at the First Affiliated Hospital of Air Force Medical University between May 2021 and January 2024 were included in this study(n=34).EAT CT attenuation,volume and PCAT CT attenuation of left anterior descending artery(LAD)and right coronary artery(RCA)were measured based on CCTA images.Left ventricular function parameters,late gadolinium enhancement(LGE),and extracellular volume(ECV)were evaluated based on CMR images.The correlations between EAT and PCAT with ventricular remodeling and myocardial fibrosis were evaluated in patients with HFrEF using Spearman analysis.Results:Spearman analysis showed that EAT volume were positively correlated with left ventricular end diastolic volume(LVEDV),left ventricular stroke volume(LVSV)and LGE(all P<0.05).EAT CT attenuation were positively correlated with LVEDV and left ventricular end systolic volume(LVESV),and negatively correlated with left ventricular remodeling index(LVRI),left ventricular ejection fraction(LVEF),left ventricular cardiac output(LVCO)and LGE(all P<0.05).LAD PCAT CT attenuation was positively correlated with LVESV,and negatively correlated with left ventricular maximal wall thickness,LVSV,LVEF,LVCO and LGE(all P<0.05).RCA PCAT CT attenuation were positively correlated with LVEDV and LVESV,and negatively correlated with LVEF and LGE(all P<0.05).EAT CT attenuation,volume and PCAT CT attenuation were not significantly correlated with ECV(all P>0.05).Conclusions:In HFrEF patients,both EAT and PCAT were associated with left ventricular remodeling and myocardial fibrosis.

关 键 词：心力衰竭 心外膜脂肪组织 冠状动脉周围脂肪组织 左心室重构 心肌纤维化 

分 类 号：R54[医药卫生—心血管疾病]