北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (6): 848-853.

• 论著 • 上一篇    下一篇

非冠心病胸痛患者心外膜脂肪与冠状动脉血流储备的相关性

张沫*,李昭屏△,李卫虹,李丹,刘丽娜,冯新恒,高炜   

  1. (北京大学第三医院心内科,卫生部心血管分子生物学与调节肽重点实验室,北京100191)
  • 出版日期:2014-12-18 发布日期:2014-12-18

Correlation between epicardial adipose tissue and coronary flow reserve in coronary heart disease patients with no chest pain

ZHANG Mo*, LI Zhao-ping△, LI Wei-hong, LI Dan, LIU Li-na, FENG Xin-heng, GAO Wei   

  1. (Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing 10019l, China)
  • Online:2014-12-18 Published:2014-12-18

摘要: 目的:分析非冠心病胸痛患者心外膜脂肪组织(epicardial adipose tissue,EAT)与冠状动脉血流储备(coronary flow reserve,CFR)的关系,探讨EAT厚度对诊断冠状动脉微循环障碍的价值。方法:冠状动脉造影或冠状动脉CT证实各冠状动脉血管直径狭窄<50%的非冠心病胸痛患者62例,经胸超声心动图测定EAT厚度及三磷酸腺苷负荷冠状动脉左前降支的CFR,分析EAT厚度与CFR的关系。结果:完成CFR测定者61例,平均CFR为2.98±0.67;其中出现冠状动脉微循环障碍,即CFR<3者34人(56%),平均CFR为2.52±0.32;CFR≥3者27人(44%),平均CFR为3.56±0.52。CFR<3组EAT厚度明显大于CFR≥3组[(3.4±0.8) mm vs. (2.3±0.6) mm,P<0.001],EAT厚度与CFR呈显著负相关(r=-0.668,P<0.001)。Logistic回归分析显示,EAT厚度是冠状动脉微循环障碍的独立影响因素(OR=7.78, 95%CI : 2.44~24.79,P=0.001)。ROC曲线分析显示,EAT厚度>2.9 mm判断冠状动脉微循环障碍(CFR<3)的敏感性为82.4%,特异性为92.3%(曲线下面积0.860,P<0.001)。结论:冠状动脉微循环障碍患者心外膜脂肪厚度增加,心外膜脂肪厚度是冠状动脉微循环障碍的独立影响因素;心外膜脂肪厚度>2.9 mm预测冠状动脉微循环障碍具有较好的敏感性和特异性。

关键词: 超声心动描记术, 心外膜脂肪, 冠状动脉血流储备, 冠状动脉循环, 微循环

Abstract: Objective:To assess whether epicardial adipose tissue (EAT) thickness is associated with coronary flow reserve (CFR) and could be used to detect coronary microvascular dysfunction. Methods: We enrolled 62 nondiabetic patients who underwent computed tomography angiography or invasive coronary angiography and had no obstructive coronary artery disease. CFR and EAT thickness were measured by transthoracic Doppler echocardiography (TTDE). Results: In the study, a total of 62 patients were enrolled, echocardiographic coronary flow reserve were obtained in 61 of the patients with a mean age of (59±10) years. 34 patients (56%) had reduced CFR (CFR<3, 2.52±0.32) suggesting microvascular dysfunction and 27 patients (44%) had normal CFR (CFR≥3, 3.56±0.52). EAT thickness was significantly increased in the patients with microvascular dysfunction as compared with those without [(3.4±0.8) mm vs. (2.3±0.6) mm, P<0.001]. EAT thickness was strongly related to CFR (r=-0.668, P<0.001). By Logistic regression analysis, EAT thickness was the independent predictor of coronary microvascular dysfunction (OR=7.78, 95%CI: 2.44-24.79). EAT thickness>2.9 mm had 82.4% sensitivity and 92.3% specificity to detect CFR<3 (area under ROC curve 0.860, P<0.001). Conclusion: EAT thickness was significantly increased in patients with coronary microvascular dysfunction. EAT thickness was independently associated with impaired CFR. EAT>2.9 mm had high sensitivity and specificity to detect coronary microvascular dysfunction.

Key words: Echocardiography, Epicardial fat, Coronary flow reserve, Coronary circulation, Microcirculation

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