基于心脏磁共振探析肥胖患者心外膜脂肪对左心室纤维化的预测价值OA

Objective:Investigating the prognostic significance of epicardial adipose tissue(EAT)surrounding the heart,as assessed through cardiac magnetic resonance(CMR),in relation to left ventricular fibrosis among individuals with obesity.Materials and Methods:We prospectively enrolled obese patients who underwent CMR examination at the First Affiliated Hospital of Wannan Medical College(Wannan Medical College Yijishan Hospital)from June 2023 to June 2025.Patients were divided into LGE(late gadolinium enhancement)positive and negative groups based on the presence or absence of myocardial fibrosis detected by CMR,and 65 healthy controls with normal body mass index(BMI)are matched.All subjects underwent CMR non-contrast and contrast-enhanced scans to measure the epicardial adipose tissue volume(EATV),EAT thickness,and left ventricular/left atrial function parameters(including conventional cardiac function parameters and myocardial strain parameters).Spearman correlation analysis was conducted to investigate the associations between EAT and myocardial strain parameters of the left ventricle and left atrium.Univariate and multivariate logistic regression analyses were performed to examine the relationship between EAT and left ventricular fibrosis.Additionally,receiver operating characteristic(ROC)curves were utilized to assess the diagnostic performance of EAT in identifying fibrosis.Results:The overall left ventricular strain in the obesity group was lower than that in the control group in all three directions(P＜0.05).The LGE(+)group showed significantly greater EAT thickness at the left atrioventricular groove(LAVG),right atrioventricular groove(RAVG),and inferior interventricular groove(IIVG),as well as significantly higher EATV,compared to the LGE(-)group and the control group(all P＜0.05).LAVG was negatively correlated with left atrial reservoir strain(Es)(ρ=-0.28,95％CI:-0.48 to-0.05,P＜0.05),left atrial conduit strain(Ee)(ρ=-0.30,95％CI:-0.50 to-0.07,P＜0.05),and overall radial strain of the left ventricle(peak radial strain,PRS)(ρ=-0.26,95％CI:-0.46 to-0.03,P＜0.05).Conversely,LAVG showed a positive correlation with the overall longitudinal strain of the left ventricle(peak longitudinal strain,PLS)(ρ=0.25,95％CI:0.06 to 0.49,P＜0.05).EATV is negatively correlated with Es(ρ=-0.28,95％CI:-0.49 to-0.05,P＜0.05),Ee(ρ=-0.34,95％CI:-0.53 to-0.12,P＜0.01),and PRS(ρ=-0.26,95％CI:-0.46 to-0.03,P＜0.05),and positively correlated with the PLS(ρ=0.30,95％CI:0.02 to 0.46,P＜0.05).IIVG was positively correlated with the PLS(ρ=0.26,95％CI:0.03 to 0.47,P＜0.05).Univariate logistic regression analysis showed that the p-values for RVAG,LAVG,IIVG,and EATV were all＜0.05;after adjusting for confounding factors,multivariate logistic regression analysis indicated that LAVG and EATV were independent predictors of left ventricular fibrosis in obese patients(P＜0.05).ROC analysis showed that the area under the curve for LAVG and EATV predicting left ventricular fibrosis was 0.841 and 0.901,respectively.Conclusions:The application of CMR technology enables precise quantification of EAT in obese patients.Both LAVG and EATV are independent predictors of left ventricular myocardial fibrosis,which holds significant clinical importance for the early detection of fibrosis.