超声测量心外膜脂肪组织厚度在慢性心力衰竭患者中的临床价值

Clinical value of epicardial adipose tissue thickness measured by transthoracic echocardiography in patients with chronic systolic heart failure

目的 ：探讨采用超声测量心外膜脂肪组织（epicardial adipose tissue,EAT）厚度,研究其评价慢性收缩性心力衰竭（心衰）患者心脏重构、心功能参数、电机械同步性等的临床价值。方法：选择78例心衰患者,平均左心室射血分数（left ventricular ejection fraction,LVEF）为31.8%±7.9%,住院期间接受常规超声心动图和组织多普勒检查,并测量EAT厚度。另选择同期健康体检者30名作为对照进行比较分析。结果：1超声测量心衰患者的右室前壁EAT厚度范围在0.3~10.2 mm间,平均厚度为（3.6±2.1）mm,其EAT厚度较对照者[（4.9±1.5）mm]显著降低（P=0.03）;根据QRS宽度将心衰患者分为2组,QRS宽度≥120 ms者的EAT厚度又显著低于QRS宽度〈120 ms者[（2.9±1.6）mm比（4.7±2.3）mm,P=0.008）]。2在心衰患者中,EAT厚度与LVEF（r=0.29,P=0.03）、肺静脉收缩期/舒张期峰值血流速度比值（r=0.42,P=0.004）、舒张早期二尖瓣血流E/二尖瓣环运动速度E′比值（E/E′）（r=-0.31,P=0.02）、心室机械收缩同步性参数左心室射血前时间（r=-0.28,P=0.047）、心室间机械延迟时间（inter ventricular mechanical delay,IVMD）（r=-0.27,P=0.049）间存在相关性。3分析心衰患者LVEF与EAT厚度间的关系发现,随着左心室收缩功能障碍加重,EAT厚度呈逐渐减少趋势,但差异尚无统计学意义（P=0.05）。4多元Logistic回归分析,在校正年龄、性别、吸烟史等因素后显示,EAT厚度并非LVEF≤35%的独立影响因素（OR=1.485,P=0.08）。结论：心衰患者的EAT厚度与其左心室收缩功能异常及心脏电机械同步性失调间有相关性。超声测量EAT能否作为评价慢性心衰患者预后的指标则需进一步研究证实。

Objective： To investigate the clinical value of epicardial adipose tissue（EAT） thickness measured by transthoracic echocardiography in patients with chronic systolic heart failure（CHF）. Methods： Seventy-eight subjects with CHF were enrolled, of them 40 were male and 38 were female, with a mean left ventricular ejection fraction（LVEF）31.8%±7.9%. Conventional echocardiographic and tissue Doppler examination were performed in all patients during hosp italization and EAT thickness was measured. Thirty healthy subjects were enrolled as the control group. Results： 1 In CHF patients, EAT thickness of anterior wall of right ventricle was 0.3-10.2 mm [mean（3.6 ±2.1） mm], significantly lower than that in the control group [（4.9±1.5） mm, P=0.03]. Subgroup analysis showed that patients with QRS width ≥120 ms had a significantly decreased EAT thickness than those with QRS width 〈120 ms [（2.9 ±1.6） mm vs（4.7 ±2.3） mm, P =0.008]. 2There was a correlation between EAT thickness and LVEF（r=0.29, P=0.03）, S/D（r=0.42, P=0.004）, E/E′（r=-0.31, P=0.02）,LVPET（r=-0.28, P=0.047） and IVMD（r=-0.27, P=0.049）. 3When the patients were divided into LVEF≤25%, 25%-35% and ≥35% subgroups, the EAT thickness showed a decreased tendency with the decline of LVEF（P=0.05）.4Logistic regression analysis showed that EAT thickness was not the independent influencing factor of LVEF≤35%（OR=1.485, P=0.08）. Conclusions： In CHF patients, EAT thickness is correlated with left ventricular dysfuntion, remodeling, and electric-mechanical dyssynchrony. The clinical value of epicardial adipose tissue in CHF is warranted to be further studied.