Epicardial Adipose Tissue as an Independent Risk Factor for Mortality in Pulmonary Arterial Hypertension.

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE

Chest Pub Date : 2025-05-01 Epub Date: 2024-11-28 DOI:10.1016/j.chest.2024.11.020

Breanne E McCarthy, Rui Feng, Drew A Torigian, Yubing Tong, Jason S Fritz, Jasleen K Minhas, Jeremy A Mazurek, K Akaya Smith, Harold I Palevsky, Steven C Pugliese, Natalie Z Homer, Margaret R MacLean, Jayaram K Udupa, Nadine Al-Naamani

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引用次数: 0

Abstract

Background: Increased epicardial adipose tissue (EAT) has adverse effects in cardiovascular diseases, independent of BMI. Estrogen levels may affect EAT accumulation. Little is known about the predictors and potential impact of EAT in pulmonary arterial hypertension (PAH).

Research question: Is EAT associated with estrogen levels, disease severity, and mortality in PAH?

Study design and methods: We conducted a retrospective cohort study of patients with PAH enrolled in the Penn Pulmonary Hypertension registry and used chest CT scans to quantify EAT. Serum estrone and estradiol levels were also measured.

Results: A total of 221 patients were included in the analysis, with median follow-up of 88 months. Mean age was 55.1 years, 74.7% were female, mean BMI was 27.20 kg/m², and the most common PAH etiology was connective tissue disease-associated PAH (43.0%) followed by idiopathic or heritable PAH (35.3%). Median EAT volume was 52.1 mL/m². Of the 102 patients with a follow-up chest CT scan, EAT increased over time in 74 (71.8%). High EAT volume (hazard ratio, 2.62; 95% CI, 1.62-4.24; P < .001) and greater accumulation of EAT over time (hazard ratio, 1.09; 95% CI, 1.01-1.17; P = .03) were both independently associated with worse survival. Patients with high EAT volume had lower serum estrone (13.70 vs 30.60 pg/mL; P = .009) and estradiol (6.05 vs 19.40 pg/mL; P = .002) levels compared with those with low EAT volume.

Interpretation: In patients with PAH, high EAT and a greater rate of accumulation of EAT volume were independently associated with worse survival. Higher EAT volume was also associated with lower estrogen levels. The association of EAT volume with survival was independent of BMI and disease severity, suggesting that EAT may be a marker for a unique PAH phenotype. Future research should investigate the role of EAT-modifying therapies in PAH and consider incorporating EAT into PAH risk models.

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心外膜脂肪组织是肺动脉高压患者死亡的独立危险因素。

背景：心外膜脂肪组织（EAT）增加对心血管疾病有不良影响，与体重指数（BMI）无关。雌激素水平可能影响EAT的积累。对于多环芳烃的预测因素和EAT的潜在影响知之甚少。研究问题：进食是否与多环芳烃患者的雌激素水平、疾病严重程度和死亡率有关？研究设计和方法：我们对宾夕法尼亚大学肺动脉高压登记处登记的PAH患者进行了一项回顾性队列研究，并使用胸部计算机断层扫描（CT）来量化EAT。我们还测量了血清雌二醇和雌二醇水平。结果：221例患者纳入分析，中位随访88个月。平均年龄55.1岁，74.7%为女性，平均BMI为27.20 kg/m2，最常见的PAH病因是结缔组织病相关的PAH(43.0%)，其次是特发性/遗传性PAH（35.3%）。中位EAT体积为52.1 mL/m2。在102例随访胸部CT的患者中，74例（71.8%）的EAT随时间增加。高EAT容量（HR 2.62, 95% CI 1.62-4.24）解释：在PAH患者中，高EAT和较大的EAT容量积累率与较差的生存率独立相关。较高的进食量也与较低的雌激素水平有关。EAT体积与生存的关联与BMI和疾病严重程度无关，这表明EAT可能是PAH独特表型的标志。未来的研究应探讨EAT调节疗法在PAH中的作用，并考虑将EAT纳入PAH风险模型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.