Prognostic value of ventricle epicardial fat volume by cardiovascular magnetic resonance in chronic heart failure.
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ABSTRACT:
SUBMITTER: Cheang I
PROVIDER: S-EPMC10196556 | biostudies-literature | 2023 May
REPOSITORIES: biostudies-literature
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Prognostic value of ventricle epicardial fat volume by cardiovascular magnetic resonance in chronic heart failure.
Cheang Iokfai I Zhu Xu X Yue Xin X Tang Yuan Y Gao Yujie Y Lu Xinyi X Shi Shi S Liao Shengen S Yao Wenming W Zhou Yanli Y Zhang Haifeng H Zhu Yinsu Y Xu Yi Y Li Xinli X
iScience 20230427 5
The purpose of this study is to explore the prognostic values of ventricle epicardial fat volume (EFV) calculated by cardiac magnetic resonance in patients with chronic heart failure (CHF). A total of 516 patients with CHF (left ventricular ejection fraction ≤ 50%) were recruited, and 136 (26.4%) of whom experienced major adverse cardiovascular events (MACE) within median follow-up of 24 months. The target marker-EFV was found to be associated with MACE in both univariate and multivariable analy ...[more]
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Project description:Background Larger epicardial fat volume (EFV) has been associated with increased risks of cardiovascular disease and atrial fibrillation. Yet, evidence on the association of EFV with cardiac function and incident heart failure (HF) remains scarce. Methods and Results We included 2103 participants (mean age, 68 years; 54.4% women) from the prospective population-based RS (Rotterdam Study) with computed tomography-based EFV and repeated echocardiography-based assessment of left ventricular (LV) systolic and diastolic function. Linear mixed effects and Cox-proportional hazard regression models, adjusted for cardiovascular risk factors, were used to assess the associations of EFV with repeated measurements of echocardiographic parameters and with incident HF. During a median follow-up of 9.7 years, 124 HF events occurred (incidence rate, 6.37 per 1000 person-years). For LV systolic function, 1-SD larger EFV was associated with 0.76 (95% CI, 0.54-0.98) mm larger LV end-diastolic dimension, 0.66 (95% CI, 0.47-0.85) mm larger LV end-systolic dimension, and 0.56% (95% CI, -0.86% to -0.27%) lower LV ejection fraction. Interactions between EFV and time were small. For LV diastolic function, 1-SD larger EFV was associated with 1.02 (95% CI, 0.78-1.27) mm larger left atrial diameter. Larger EFV was also associated with incident HF (hazard ratio per 1-SD increase in EFV, 1.34 [95% CI, 1.07-1.68] per 1-SD larger EFV). Conclusions We report an independent association between EFV with new-onset HF in the general population. EFV seems to exert its influence on HF through different pathways contributing to deteriorations in systolic function and larger left atrial size in part, likely through mechanical restraint and hypertrophy.
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Project description:BackgroundIn the context of acute ST-segment elevation myocardial infarction (STEMI), epicardial fat volume (EFV) has a significant impact on the formation of microvascular obstruction (MVO). This study aimed to quantitatively measure the EFV and myocardial strain parameters by cardiac magnetic resonance (CMR) and to explore their relationship with the presence or absence of mcrocirculation dysfunction after myocardial infarction.MethodsThis was a retrospective study. From June 2022 to December 2023, 56 consecutive patients diagnosed with acute STEMI who underwent percutaneous coronary intervention (PCI) were selected from The First Affiliated Hospital of Bengbu Medical University. Patients were divided into two groups based on the presence of MVO group and the non-MVO (NMVO) group, with 22 cases (39%) and 34 cases (61%) respectively. The characteristics of the infarction were assessed by delayed enhancement with gadolinium. Based on standard cine images, the global circumferential strain (GCS), global radial strain (GRS), and global longitudinal strain (GLS) of the left and right ventricles were evaluated using CMR feature tracking (CMR-FT) imaging. The volume of EFV was quantified along the short-axis slices of the left and right ventricles at the end of diastole by CMR imaging. The differences in baseline characteristics, EFV, and myocardial strain parameters between the groups were compared using Pearson or Spearman correlation analysis. The specificity and sensitivity of myocardial strain parameters in predicting MVO were obtained using receiver operating characteristic (ROC) curves. The predictive factors for MVO were analyzed using univariate and multivariate logistic regression analyses.ResultsA total of 56 patients were selected, with an average age of 59.84±12.37 years, including 42 males (75%) and 14 females (25%). There was a statistically significant difference in EFV between the MVO group and the NMVO group (P<0.001). The prediction model for MVO based on EFV [area under the ROC curve (AUC): 0.856; 95% confidence interval (CI): 0.736-0.935; sensitivity: 77.27%; specificity: 91.18%], GLS (AUC: 0.929; 95% CI: 0.828-0.980; sensitivity: 90.90%; specificity: 94.12%), GCS (AUC: 0.770; 95% CI: 0.638-0.872; sensitivity: 86.36%; specificity: 61.76%), GRS (AUC: 0.789; 95% CI: 0.659-0.886; sensitivity: 90.19%; specificity: 70.59%). The left ventricular ejection fraction in the MVO group was lower than that in the NMVO group (P=0.001). The GLS, GRS, and GCS in the MVO group were significantly lower than those in the NMVO group (P<0.001). Correlation analysis found that EFV (r=0.602, P<0.001), GLS (r=0.726, P<0.001), GCS (r=0.457, P<0.001) was significantly positively correlated with postoperative myocardial infarction with mcrocirculation obstruction, while GRS (r=-0.486, P<0.001) were negatively correlated with postoperative myocardial infarction with mcrocirculation obstruction.ConclusionsAfter myocardial infarction, there is more EFV in the presence of mcrocirculation dysfunction, and the local myocardial function is reduced more. Monitoring EFV plays a significant role in the early anti-lipid treatment strategy for patients with MVO.
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Project description:BackgroundOne-third of ischemic strokes are "cryptogenic" without clearly identified etiology. Although coronary artery disease (CAD) is the main cause of death after stroke, the interest in CAD screening in patients with cryptogenic stroke is still debated.AimThe aim of the study was to assess the incremental prognostic value of stress cardiovascular magnetic resonance (CMR) beyond traditional risk factors for predicting cardiovascular events in patients with a prior cryptogenic ischemic stroke.Materials and methodsBetween 2008 and 2021, consecutive patients with prior cryptogenic strokes referred for stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACEs), defined by cardiovascular death or non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia.ResultsOf 542 patients (55.2% male, mean age 71.4 ± 8.8 years) who completed the follow-up (median 5.9 years), 66 (12.2%) experienced MACE. Silent ischemia and unrecognized MI were detected in 18 and 17% of patients, respectively. Using Kaplan-Meier analysis, silent ischemia and unrecognized MI were associated with the occurrence of MACE [hazard ratio, HR: 8.43 (95% CI: 5.11-13.9); HR: 7.87 (95% CI: 4.80-12.9), respectively, p < 0.001]. In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of MACE [HR: 8.08 (95% CI: 4.21-15.5); HR: 6.65 (95% CI: 3.49-12.7), respectively, p < 0.001]. After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C-statistic improvement: 0.13; NRI = 0.428; IDI = 0.048).ConclusionIn patients with prior cryptogenic stroke, stress CMR findings have an incremental prognostic value to predict MACE over traditional risk factors.
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