心外膜脂肪组织对心房颤动致心动过速性心肌病鉴别诊断价值

Differential diagnosis value of epicardial adipose tissue for atrial fibrillation induced tachycardiomyopathy

目的探讨心外膜脂肪组织对心房颤动(AF)致心动过速性心肌病(AF-TCM)与特发性扩张型心肌病(IDCM)伴AF的鉴别诊断作用。方法收集2014年1月至2019年7月在宁波市第一医院心内科接受射频导管消融术的AF合并IDCM患者,将随访终点1年时维持窦性心律的患者分为2组,将左心室射血分数(LVEF)恢复正常(>50%)的患者作为AF-TCM组(n=36),经性别、年龄、体重指数匹配后LVEF未恢复(<45%)患者作为IDCM-AF组(n=18),经心脏增强CT测定术前左心房心外膜脂肪组织(LA-EAT)与左心室心外膜脂肪组织(LV-EAT)最厚厚度与体积。结果AF-TCM组LA-EAT体积与LA-EAT/LV-EAT体积比均高于IDCM-AF组[(57.97±7.82)cm^(3)对(45.31±6.36)cm^(3);0.55±0.10对0.37±0.06,P<0.01],IDCM-AF组LV-EAT体积高于AF-TCM组[(122.98±9.89)cm^(3)对(105.24±10.11)cm^(3),P<0.01]。二元Logistic回归分析发现LA-EAT体积(OR=1.369,95%CI 1.082~1.908,P<0.05)及LA-EAT/LV-EAT体积比(OR=5.334,95%CI 2.783~13.677,P<0.05)是AF-TCM的独立危险因素。受试者工作特征(ROC)曲线分析示LA-EAT体积>52.35 cm^(3)[敏感性66.7%、特异性88.9%,曲线下面积(AUC)=0.890,95%CI 0.799~0.980,P<0.01)]对鉴别诊断AF-TCM优于LA-EAT/LV-EAT体积比>0.425[敏感性97.1%,特异性83.3%(AUC=0.948,95%CI 0.890~1.000,P<0.01)]。结论LA-EAT体积与LA-EAT/LV-EAT体积比对AF-TCM及IDCM-AF具有一定鉴别诊断价值,以后者为优。

Objective To evaluate the role of epicardial adipose tissue in the differential diagnosis of atrial fibrillation(AF)induced tachycardiomyopathy(AF-TCM)and idiopathic dilated cardiomyopathy with AF(IDCM-AF).Methods Consecutive patients with AF complicated IDCM who underwent radiofrequency catheter ablation(RFCA)in Ningbo First Hospital from January 2014 to July 2019 were enrolled.Patients maintained sinus rhythm(SR)after one-year were divided into two groups:patients with left ventricular ejection fraction(LVEF)>50%(AF-TCM group,n=36)and those LVEF did not return(<45%)(IDCM-AF group,n=18)after age,gender and body mass index matched.The maximum thickness,and volume of left atrial epicardial adipose tissue(LA-EAT)and left ventricular epicardial adipose tissue(LV-EAT)were measured with cardiac enhanced CT in a week following RFCA.Results LA-EAT volume and LA-EAT/LV-EAT volume ratio in AF-TCM group were greater than that in IDCM-AF group[(57.97±7.82)cm^(3) vs.(45.31±6.36)cm^(3);0.55±0.10 vs.0.37±0.06;P<0.01],while the volume of LV-EAT was greater in IDCM-AF group[(122.98±9.89)cm^(3) vs.(105.24±10.11)cm^(3),P<0.01].Binary Logistic regression analysis showed that volume of LA-EAT(OR=1.369,95%CI 1.082-1.908,P<0.05)and LA-EAT/LV-EAT volume ratio(OR=5.334,95%CI 2.783-13.677,P<0.05)were independent risk factors for AF-TCM.The ROC analysis revealed that LA-EAT volume>52.35 cm^(3)(sensitivity:66.7%,specificity:88.9%,and area under the curve=0.890,95%CI 0.799-0.980,P<0.01)and LA-EAT/LV-EAT volume ratio>0.425(sensitivity:97.1%,specificity:83.3%,and area under the curve=0.948,95%CI 0.890-1.000,P<0.01)were associated with AF-TCM.Conclusion The LA-EAT volume and LA-EAT/LV-EAT volume ratio could differentiate AF-TCM patients from those with IDCM-AF,and LA-EAT/LV-EAT volume ratio might be a preferential one.