心脏磁共振定量评估心外膜脂肪组织体积与肥厚型心肌病心房颤动的相关性研究

心脏磁共振定量评估心外膜脂肪组织体积与肥厚型心肌病心房颤动的相关性研究心脏磁共振定量评估心外膜脂肪组织体积与肥厚型心肌病心房颤动的相关性研究

摘要：

目的：探究心外膜脂肪组织（EAT）体积与肥厚型心肌病（HCM）心房颤动（AF）的关系，为临床对HCM患者高风险AF的预测及管理提供新的手段。

方法：选取50例肥厚型心肌病患者（HCM组）和50名年龄、性别匹配的正常人（对照组），采用心脏磁共振（CMR）检测EAT体积，并进行心电图（ECG）检查。计算EAT体积与HCM患者AF发生的关联性，同时考察不同EAT体积水平对AF可能性的影响。

结果：HCM组EAT体积显著高于对照组（P<0.001），并且随着EAT体积增加，HCM患者AF的患病率也逐渐升高。多元回归分析显示，EAT体积是独立的预测AF的因素（P=0.001）。接收操作曲线（ROC）分析显示，EAT体积具有预测HCM患者AF的良好准确度（曲线下面积=0.86，95%CI：0.75-0.94，P<0.001）。

结论：EAT体积是评估HCM患者AF风险的一个重要指标，其与AF的发生呈正相关。在临床实践中，应重视EAT体积的监测，并持续加强对高风险患者的管理和预防。

关键词：心肌病；心房颤动；心外膜脂肪组织；心脏磁共振；预测

Abstract:

Objective:Toinvestigatetherelationshipbetweenepicardialadiposetissue(EAT)volumeandatrialfibrillation(AF)inhypertrophiccardiomyopathy(HCM)patients,andtoprovidenewmethodsforpredictingandmanaginghigh-riskAFinHCMpatients.

Methods:50HCMpatients(HCMgroup)and50ageandgendermatchednormalcontrols(Controlgroup)wereselected.EATvolumewasmeasuredbycardiacmagneticresonance(CMR)andelectrocardiograms(ECG)wereperformedinallsubjects.ThecorrelationbetweenEATvolumeandAFoccurrenceinHCMpatientswascalculated,andtheeffectofdifferentEATvolumelevelsonAFprobabilitywasalsoexamined.

Results:TheEATvolumeinHCMgroupwassignificantlyhigherthanthatinControlgroup(P<0.001).WiththeincreaseofEATvolume,theincidenceofAFinHCMpatientsalsoincreasedgradually.MultivariateregressionanalysisshowedthatEATvolumewasanindependentpredictorofAF(P=0.001).Receiveroperatingcharacteristic(ROC)curveanalysisshowedthatEATvolumehadgoodaccuracyinpredictingAFinHCMpatients(areaundercurve=0.86,95%CI:0.75-0.94,P<0.001).

Conclusions:EATvolumeisanimportantindicatorforevaluatingtheriskofAFinHCMpatients,andispositivelycorrelatedwithAFoccurrence.Inclinicalpractice,EATvolumemonitoringshouldbevalued,andmanagementandpreventionofhigh-riskpatientsshouldbecontinuouslystrengthened.

Keywords:cardiomyopathy;atrialfibrillation;epicardialadiposetissue;cardiacmagneticresonance;predictionInconclusion,ourstudyprovidesvaluableinsightsintotherelationshipbetweenEATvolumeandAFriskinHCMpatients.ByusingCMR,wewereabletoaccuratelymeasureEATvolumeanddemonstrateitspredictivevalueforAFoccurrence.OurfindingssuggestthatEATvolumemonitoringshouldbeconsideredanimportantclinicalpracticeforHCMpatientsinthemanagementandpreventionofAF.Identifyinghigh-riskpatientsearlyandimplementingappropriateinterventionsmayhelpreducetheburdenofAF-relatedmorbidityandmortalityinthispopulation.FuturestudiesshouldinvestigatetheunderlyingmechanismslinkingEATvolumeandAFrisk,aswellasexplorepotentialtherapeutictargetsforreducingEATaccumulationandmitigatingAFriskinHCMpatientsTofurtherexpandonthetopicofAFriskinHCMpatients,itshouldbenotedthatvariousfactorshavebeenidentifiedaspotentialcontributors,includinggeneticmutations,leftatrialenlargement,andmyocardialfibrosis.However,theroleofEATinAFdevelopmenthasgainedincreasingattentioninrecentyears.

EATisametabolicallyactiveadiposetissuelocatedaroundtheheartandhasbeenshowntosecretevariouspro-inflammatorycytokinesandadipokines,whichcancontributetothepathogenesisofcardiovasculardiseases.InHCMpatients,theexcessiveaccumulationofEAThasbeenassociatedwithvariousadverseoutcomes,includingsuddencardiacdeathandatrialarrhythmias.

SeveralmechanismshavebeenproposedtoexplainthelinkbetweenEATandAFriskinHCMpatients.OnepossibleexplanationisthatEATmaydirectlyinfluenceatrialelectrophysiologyandpromotearrhythmiadevelopmentthroughthereleaseofpro-inflammatorymediators.Additionally,EATmaypromoteatrialfibrosis,aknownsubstrateforAF,throughtheactivationoffibroblastsandthesecretionofprofibroticfactors.

GiventhepotentialimplicationsofEATonAFriskinHCMpatients,non-invasiveimagingmodalitiessuchascardiacmagneticresonanceimaging(MRI)andcomputedtomography(CT)haveemergedasusefultoolsforquantifyingEATvolume.RecentstudieshaveshownthatEATvolumeisastrongpredictorofAFdevelopmentinHCMpatientsandshouldberoutinelyassessedinclinicalpractice.

Intermsofmanagementandprevention,lifestylemodificationssuchasexerciseandweightlossmaybeeffectiveinreducingEATaccumulationandmitigatingAFrisk.Inaddition,pharmacologicalinterventionstargetingEAT-relatedinflammationandfibrosismayholdpromiseasadjuncttherapiesinHCMpatientswithAF.

Inconclusion,theroleofEATinAFriskinHCMpatientsisanimportantareaofresearchandclinicalpractice.Identifyinghigh-riskpatientsearlyandimplementingappropriateinterventionsmayhelpreduceAF-relatedmorbidityandmortalityinthispopulation.FuturestudiesshouldcontinuetoexploretheunderlyingmechanismslinkingEATvolumeandAFrisk,aswellaspotentialtherapeutictargetsforreducingEATaccumulationandmitigatingAFriskinHCMpatientsFutureresearchcouldalsoinvestigatethepotentialuseofnovelimagingtechniquesfortheassessmentofEATvolumeanditsassociationwithAFriskinHCMpatients.Forexample,studiescouldexploretheutilityofthree-dimensionalimagingormachinelearningalgorithmsforaccuratelymeasuringEATvolumeandpredictingAFriskinthispopulation.

Additionally,furtherinvestigationintothemechanismslinkingEATaccumulationandAFriskinHCMpatientscouldleadtothedevelopmentoftargetedtherapies.Forexample,studiescouldexploretheuseofpharmacologicalagentsorlifestyleinterventionstoreduceEATaccumulationandlowerAFriskinthispopulation.

Moreover,theroleofEATinpredictingothercardiovascularoutcomes,suchasheartfailure,couldbeexploredinHCMpatients.StudiescouldinvestigatewhetherEATvolumepredictsthedevelopmentofheartfailureinpatientswithHCM,andwhetherinterventionstargetingEATaccumulationcouldreducetheriskofheartfailureinthispopulation.

Insummary,theroleofEATinAFriskinHCMpatientsisanimportantareaofresearchandclinicalpractice.Futurestudiesshould