Impact of epicardial adipose tissue on myocardial function and structure in patients with severe aortic valve stenosis.

IF 3.7 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Judith Gronwald, Torben Lange, Sören J Backhaus, Bo E Beuthner, Ruben Evertz, Miriam Puls, Johannes T Kowallick, Karl Toischer, Gerd Hasenfuß, Andreas Schuster, Alexander Schulz
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引用次数: 0

Abstract

Aims: Epicardial adipose tissue (EAT) is closely associated with the development of heart failure and adverse myocardial remodelling. In patients with severe aortic valve stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), increased EAT has been identified as a predictor of adverse outcomes; however, the underlying pathophysiological mechanisms remain unclear. This study aims to explore the effects of increased EAT volumes on myocardial remodelling and dysfunction in patients with severe AS.

Methods and results: One hundred thirty-seven patients with severe AS (median age 80 years, 62% male) underwent cardiac magnetic resonance imaging (CMR) prior to TAVR. Myocardial volumes and function as well as EAT volumes were quantified from CMR acquisitions. The cohort was dichotomised at the median EAT volume. Patients with increased EAT volumes above the median (≥46.5 mL/m2) showed impaired left atrial (LA) reservoir strain (Es) as a distinct functional feature compared with patients with lower EAT volumes (11.8% [7.6-16.7] vs. 15.0% [10.9-19.1], P = 0.011), while left ventricular (LV) morphology and function (all P ≥ 0.216), right atrial and ventricular morphology and function (all P ≥ 0.090), as well as tissue characteristics (all ≥ 0.229) were similar between both groups. In a subgroup analysis of the four types of severe AS, the difference was most prominent in patients with low ejection fraction high-gradient AS. In multivariable regression analyses, EAT was independently associated with impaired LA Es, irrespective of co-morbidities, ventricular function, tissue characteristics and functional characteristics of AS.

Conclusions: In patients with severe AS, increased EAT volume is independently associated with impaired LA function but not with other features of biventricular morphology, function or tissue composition. The incremental deterioration of LA function, in addition to the afterload imposed by AS in these patients, could increase vulnerability to heart failure and may require consideration as a therapeutic target beyond TAVR.

重度主动脉瓣狭窄患者心外膜脂肪组织对心肌功能和结构的影响。
目的:心外膜脂肪组织(EAT)与心力衰竭和不良心肌重构的发展密切相关。在接受经导管主动脉瓣置换术(TAVR)的严重主动脉瓣狭窄(AS)患者中,增加的EAT已被确定为不良结局的预测因子;然而,潜在的病理生理机制尚不清楚。本研究旨在探讨进食量增加对严重AS患者心肌重构和功能障碍的影响。方法和结果:137例严重AS患者(中位年龄80岁,男性62%)在TAVR之前接受了心脏磁共振成像(CMR)。心肌体积和功能以及EAT体积通过CMR采集进行量化。按中位进食容积对队列进行二分。EAT容积高于中位数(≥46.5 mL/m2)的患者与EAT容积较低的患者相比(11.8% [7.6-16.7]vs. 15.0% [10.9-19.1], P = 0.011),左心室(LV)形态和功能(均P≥0.216)、右心房和心室形态和功能(均P≥0.090)以及组织特征(均≥0.229)在两组之间相似。在四种类型严重AS的亚组分析中,低射血分数高梯度AS患者的差异最为突出。在多变量回归分析中,与AS的合并症、心室功能、组织特征和功能特征无关,EAT与LA Es受损独立相关。结论:在严重AS患者中,EAT体积增加与LA功能受损独立相关,但与双心室形态、功能或组织组成的其他特征无关。在这些患者中,LA功能的逐渐恶化,加上AS带来的后负荷,可能增加心力衰竭的易损性,可能需要考虑将其作为TAVR以外的治疗靶点。
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来源期刊
ESC Heart Failure
ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine
CiteScore
7.00
自引率
7.90%
发文量
461
审稿时长
12 weeks
期刊介绍: ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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