Correlation study of epicardial adipose tissue volume and essential hypertension with coronary heart disease

doi:10.3969/j.issn.1004-583X.2021.08.005

Abstract

Abstract:

Objective To explore the relationship between epicardial adipose tissue(EAT) volume and essential hypertension(EH) with coronary heart disease(CHD) for its pathogenic risk and predictive value. Methods The study involved 408 patients with EH who underwent coronary computed tomographic angiography(CCTA) from December 2014 to June 2017 in our hospital. The patients were divided into study group (n=319) and control group (n=89) by CCTA diagnosis of CHD and non-CHD. The differences in terms of clinical baseline characteristics and EAT volume between two groups were compared. Receiver operating characteristic (ROC) curve were used to assess the diagnostic value of EAT volume for EH with CHD and to determine the optimal cut-off value. Logistic regression analysis to assess risk factors for combined CHD in EH. EAT volume with Gensini score and coronary artery calcification score (CACS) were evaluated with Spearman correlation analysis. Results The EAT volume was higher in CHD group than in non-CHD group (P<0.05). ROC curve analysis showed that the AUC of EAT volume in diagnosing EH combined CHD was 0.698(P<0.05). When the truncation value of EAT volume was 172.5 cm³, the diagnostic EH concurrent CHD was most effective, with the sensitivity and specificity of 42.7% and 94.3%. Multi-factor logistic regression analysis showed that EAT volume≥172.5 cm³ was independent risk factors for EH combined with CHD(P<0.05), the relative hazard level was 10.050(3.459-29.204).Spearman correlation analysis showed that EAT volume was positively correlated with Gensini scores and CACS (r=0.207, 0.235, P<0.05). Conclusion Measurement of EAT volume by CCTA may be a new clinical non-invasive diagnostic tool for EH with CHD. EAT volume was positively correlated with Gensini score and CACS in patients with EH. High EAT volume was an independent risk factor for EH with CHD.

Key words: coronary artery disease, epicardial mapping, hypertension, risk factors, diagnosis

CLC Number:

R541.4

Wang Yazhu, Guo Yunfei, Si Yueqiao, Liu Chao, Zhang Ying. Correlation study of epicardial adipose tissue volume and essential hypertension with coronary heart disease[J]. Clinical Focus, 2021, 36(8): 699-703.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2021.08.005

https://huicui.hebmu.edu.cn/EN/Y2021/V36/I8/699

Figures/Tables 4

References 18

[1]	Wu B, Ren Z, Du Z, et al. The relationship between quantitative epicardial adipose tissue based on CT and coronary artery disease: A protocol for systematic review and meta-analysis[J]. Medicine (Baltimore), 2020, 99(51):e23729. doi: 10.1097/MD.0000000000023729 URL
[2]	Erdogan G, Belen E, Sungur MA, et al. Assessment of epicardial adipose tissue thickness in patients with resistant hypertension[J]. Blood Press Monit, 2016, 21(1):16-20. doi: 10.1097/MBP.0000000000000149 pmid: 26317386
[3]	Austys D, Dobrovolskij A, Jablonskienè V, et al. Epicardial adipose tissue accumulation and essential hypertension in non-obese adults[J]. Medicina (Kaunas), 2019, 55(8):456.
[4]	Zhou L, Deng Y, Gong J, et al. Epicardial adipose tissue volume a diagnostic study for independent predicting disorder of circadian rhythm of blood pressure in patients with essential hypertension[J]. Cell Mol Biol (Noisy-le-grand), 2016, 62(6):1-7.
[5]	Sato T, Aizawa Y, Yuasa S, et al. The effect of dapagliflozin treatment on epicardial adipose tissue volume[J]. Cardiovasc Diabetol, 2018, 17(1):6. doi: 10.1186/s12933-017-0658-8 URL
[6]	张彦月, 李旭, 林文华, 等. 心外膜脂肪组织容积与冠心病介入治疗患者临床预后的关系[J]. 中华医学杂志, 2018, 98(3):208-212.
[7]	中国高血压防治指南修订委员会, 高血压联盟(中国), 中华医学会心血管病学分会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1):24-56.
[8]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10(1):4-67.
[9]	诸骏仁, 高润霖, 赵水平, 等. 中国成人血脂异常防治指南(2016年修订版)[J]. 中国循环杂志, 2016, 31(10):937-953.
[10]	Yamashita K, Yamamoto MH, Igawa W, et al. Association of epicardial adipose tissue volume and total coronary plaque burden in patients with coronary artery disease[J]. Int Heart J, 2018, 59(6):1219-1226. doi: 10.1536/ihj.17-709 URL
[11]	Meng X, Wang W, Zhang K, et al. Epicardial adipose tissue volume is associated with non-alcoholic fatty liver disease and cardiovascular risk factors in the general population[J]. Ther Clin Risk Manag, 2018, 14:1499-1506. doi: 10.2147/TCRM URL
[12]	Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease[J]. Am J Cardiol, 1983, 51(3):606. pmid: 6823874
[13]	李晓玲, 陈燕燕. 肥胖伴糖尿病及冠心病患者的体重管理[J]. 中国循环杂志, 2019, 34(11):1130-1133.
[14]	Christensen RH, von Scholten BJ, Hansen CS, et al. Epicardial adipose tissue predicts incident cardiovascular disease and mortality in patients with type 2 diabetes[J]. Cardiovasc Diabetol, 2019, 18(1):114. doi: 10.1186/s12933-019-0917-y pmid: 31470858
[15]	韩超, 崔志新, 丁振江, 等. 心表面脂肪体积与稳定型心绞痛患病的相关性[J]. 临床心血管病杂志, 2019, 35(9):785-789.
[16]	Iwasaki K, Urabe N, Kitagawa A, et al. The association of epicardial fat volume with coronary characteristics and clinical outcome[J]. Int J Cardiovasc Imaging, 2018, 34(2):301-309. doi: 10.1007/s10554-017-1227-7 URL
[17]	张晗晖, 孟祥彬, 王文尧, 等. 社区人群心外膜脂肪体积与冠心病危险因素和冠状动脉钙化积分的关系[J]. 中华心血管病杂志, 2018, 46(5):364-369.
[18]	Stein R, Ferrari F, Scolari F. Genetics, dyslipidemia, and cardiovascular disease: New insights[J]. Curr Cardiol Rep, 2019, 21(8):68. doi: 10.1007/s11886-019-1161-5 URL

项目	研究组(n=319)	对照组(n=89)	χ²/Z值	P值
年龄≥60岁[例(%)]	169.00(52.98)	41.00(46.07)	1.330	0.249
男性[例(%)]	195.00(61.13)	29.00(32.58)	22.899	<0.001
2型糖尿病[例(%)]	98.00(30.72)	12.00(13.48)	10.500	0.001
吸烟[例(%)]	136.00(42.63)	22.00(24.72)	9.278	0.002
饮酒[例(%)]	75.00(23.51)	16.00(17.98)	1.186	0.276
CHD家族史[例(%)]	31.00(9.72)	9.00(10.11)	0.010	0.922
血脂异常[例(%)]	98.00(30.72)	33.00(37.08)	1.280	0.258
BMI≥24 kg/m²[例(%)]	239.00(74.92)	56.00(62.92)	5.004	0.025
心率(次/min)	72.00(66, 78)	72.00(66, 81)	-1.580	0.114
收缩压(mmHg)	140.00(130, 160)	144.00(130, 155)	-0.290	0.772
舒张压(mmHg)	85.00(80, 95)	90.00(80.00, 97.50)	-1.420	0.156
空腹血糖(mmol/L)	5.52(4.90, 6.82)	5.43(4.93, 6.50)	-0.972	0.331
白细胞(×10⁹/L)	6.72(5.54, 8.01)	7.00(5.53, 8.18)	-0.670	0.503
中性粒细胞百分比(%)	61.60(55.50, 67.90)	61.10(54.18, 67.25)	-0.562	0.574
淋巴细胞百分比(%)	28.75(22.37, 34.02)	30.25(25.25, 36.00)	-1.696	0.090
血小板计数(×10⁹/L)	222.00(185.50, 256.00)	229.50(195.50, 273.25)	-1.326	0.185
肌酐(μmol/L)	68.97(59.80, 80.445)	63.40(54.35, 74.13)	-2.906	0.004
尿素氮(mmol/L)	5.36(4.43, 6.37)	4.97(3.93, 5.84)	-2.368	0.018
尿酸(μmol/L)	316.20(263.45, 370.90)	312.55(256.78, 366.00)	-0.400	0.689
LDL-C≥3.40 mmol/L[例(%)]	49.00(15.36)	6.00(6.74)	3.544	0.046
HDL-C≤1.00 mmol/L[例(%)]	141.00(44.20)	47.00(52.81)	2.075	0.150
TG≥1.70 mmol/L[例(%)]	170.00(53.29)	42.00(47.19)	1.037	0.308
TC≥5.20 mmol/L[例(%)]	128.00(41.13)	10.00(11.24)	25.946	<0.001
EAT体积( cm³)	140.50(97.97, 231.25)	102(77.02, 131.50)	-5.680	<0.001
CACS(分)	197.00(26.00, 568.00)	0.00(0, 0)	-11.72	<0.001
Gensini 积分(分)	24.50(14.5, 52)	0.00(0, 0)	-14.296	<0.001

项目	研究组(n=319)	对照组(n=89)	χ²/Z值	P值
年龄≥60岁[例(%)]	169.00(52.98)	41.00(46.07)	1.330	0.249
男性[例(%)]	195.00(61.13)	29.00(32.58)	22.899	<0.001
2型糖尿病[例(%)]	98.00(30.72)	12.00(13.48)	10.500	0.001
吸烟[例(%)]	136.00(42.63)	22.00(24.72)	9.278	0.002
饮酒[例(%)]	75.00(23.51)	16.00(17.98)	1.186	0.276
CHD家族史[例(%)]	31.00(9.72)	9.00(10.11)	0.010	0.922
血脂异常[例(%)]	98.00(30.72)	33.00(37.08)	1.280	0.258
BMI≥24 kg/m²[例(%)]	239.00(74.92)	56.00(62.92)	5.004	0.025
心率(次/min)	72.00(66, 78)	72.00(66, 81)	-1.580	0.114
收缩压(mmHg)	140.00(130, 160)	144.00(130, 155)	-0.290	0.772
舒张压(mmHg)	85.00(80, 95)	90.00(80.00, 97.50)	-1.420	0.156
空腹血糖(mmol/L)	5.52(4.90, 6.82)	5.43(4.93, 6.50)	-0.972	0.331
白细胞(×10⁹/L)	6.72(5.54, 8.01)	7.00(5.53, 8.18)	-0.670	0.503
中性粒细胞百分比(%)	61.60(55.50, 67.90)	61.10(54.18, 67.25)	-0.562	0.574
淋巴细胞百分比(%)	28.75(22.37, 34.02)	30.25(25.25, 36.00)	-1.696	0.090
血小板计数(×10⁹/L)	222.00(185.50, 256.00)	229.50(195.50, 273.25)	-1.326	0.185
肌酐(μmol/L)	68.97(59.80, 80.445)	63.40(54.35, 74.13)	-2.906	0.004
尿素氮(mmol/L)	5.36(4.43, 6.37)	4.97(3.93, 5.84)	-2.368	0.018
尿酸(μmol/L)	316.20(263.45, 370.90)	312.55(256.78, 366.00)	-0.400	0.689
LDL-C≥3.40 mmol/L[例(%)]	49.00(15.36)	6.00(6.74)	3.544	0.046
HDL-C≤1.00 mmol/L[例(%)]	141.00(44.20)	47.00(52.81)	2.075	0.150
TG≥1.70 mmol/L[例(%)]	170.00(53.29)	42.00(47.19)	1.037	0.308
TC≥5.20 mmol/L[例(%)]	128.00(41.13)	10.00(11.24)	25.946	<0.001
EAT体积( cm³)	140.50(97.97, 231.25)	102(77.02, 131.50)	-5.680	<0.001
CACS(分)	197.00(26.00, 568.00)	0.00(0, 0)	-11.72	<0.001
Gensini 积分(分)	24.50(14.5, 52)	0.00(0, 0)	-14.296	<0.001

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
男性	1.228	0.304	16.266	<0.001	3.414	1.880	6.201
吸烟	1.060	0.428	666.136	0.008	2.887	1.850	5.807
2型糖尿病	0.937	0.402	5.439	0.020	2.552	1.161	5.607
TC≥5.18 mmol/L	1.695	0.405	17.538	0.002	5.448	2.464	12.046
EAT体积≥172.5 cm³	2.308	0.544	17.978	<0.001	10.05	3.459	29.204
常数项	1.732	0.880	3.869	0.047	5.65

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
男性	1.228	0.304	16.266	<0.001	3.414	1.880	6.201
吸烟	1.060	0.428	666.136	0.008	2.887	1.850	5.807
2型糖尿病	0.937	0.402	5.439	0.020	2.552	1.161	5.607
TC≥5.18 mmol/L	1.695	0.405	17.538	0.002	5.448	2.464	12.046
EAT体积≥172.5 cm³	2.308	0.544	17.978	<0.001	10.05	3.459	29.204
常数项	1.732	0.880	3.869	0.047	5.65

指标	EAT体积
指标	r值	P值
CACS(分)	0.235	<0.001
Gensini积分(分)	0.207	<0.001
年龄(岁)	0.018	0.714
BMI(kg/m²)	0.312	<0.001
空腹血糖(mmol/L)	0.097	0.064
心率(次/min)	0.017	0.728
收缩压(mmHg)	-0.068	0.176
舒张压(mmHg)	-0.064	0.188
白细胞(×10⁹/L)	0.073	0.161
中性粒细胞百分比(%)	0.027	0.596
淋巴细胞百分比(%)	-0.053	0.301
血小板计数(×10⁹/L)	-0.061	0.230
肌酐(μmol/L)	0.080	0.153
尿素氮(mmol/L)	0.062	0.239
尿酸(μmol/L)	0.069	0.173
LDL-C(mmol/L)	-0.003	0.961
HDL-C(mmol/L)	-0.161	0.002
TG(mmol/L)	0.082	0.107
TC(mmol/L)	-0.029	0.572