Epicardial fat volume is related to the degree of cardiac allograft vasculopathy,European Radiology

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Epicardial fat volume is related to the degree of cardiac allograft vasculopathy
European Radiology ( IF 4.7 ) Pub Date : 2022-08-20 , DOI: 10.1007/s00330-022-09029-2
Stefan Roest _{1,

2} , Ricardo P J Budde _{1,

3} , Jasper J Brugts _{1,

2} , Jan von der Thüsen _{2,

4} , Theo van Walsum ₃ , Yannick J H J Taverne _{2,

5} , Felix Zijlstra ₁ , Daniel Bos _{3,

6} , Olivier C Manintveld _{2,

7}

Affiliation

Objectives

Increasing evidence suggests a role for epicardial fat in the development of coronary artery disease in the general population. Heart transplantation patients are at increased risk of developing a specific form of coronary artery disease, cardiac allograft vasculopathy (CAV), which has far-reaching consequences in terms of morbidity and mortality. Until now, the role of epicardial fat volume (EFV) in the development of CAV remains unknown. Hence, we investigated the relationship between EFV and CAV as well as the influence of donor/recipient sex on EFV.

Methods

Adult heart transplant patients who underwent coronary computed tomography angiography (CCTA) for CAV screening who were four or more years post-HT were included. Using the CT examinations, we quantified the EFV and the degree of CAV. Ordinal and linear regression models were used to assess the association of EFV with CAV.

Results

In total, 149 (median age 44.5 years, 36% women) patients were included. The median time between HT and the CT scan was 11.0 (7.3–16.1) years. CAV grade 0, 1, 2 and 3 were seen in 85 (57%), 32 (22%), 14 (9%), and 18 (12%) patients, respectively. The median EFV was 208.4 (128.9–276.0) mL. Larger EFV were related to higher degrees of CAV (median of 164.7 to 290.6 mL for CAV grade 0 and 3, respectively, OR 5.23 (2.47–11.06), p < 0.001). Male recipients had significantly more EFV than female recipients irrespective of the donor sex (232.7 mL vs. 147.2 mL respectively, p < 0.001). Determinants for EFV were recipient sex, number of rejections, donor age, time between HT and CT scan, recipient BMI, and diabetes mellitus.

Conclusions

EFV was associated with higher degrees of CAV. The recipient sex influenced the EFV more than the donor sex.

Key Points

• Patients after heart transplantation have a high amount of epicardial fat while larger amounts of epicardial fat are related to higher grades of cardiac allograft vasculopathy.

• Determinants of higher epicardial fat volume included recipient sex, number of rejections, donor age, time between HT and CT scan, recipient BMI, and diabetes mellitus.

• Longitudinal studies are needed to further disentangle the role of epicardial fat in the development and progression of cardiac allograft vasculopathy.

Graphical abstract

中文翻译：

心外膜脂肪体积与心脏同种异体移植血管病变程度相关

目标

越来越多的证据表明，心外膜脂肪在普通人群冠状动脉疾病的发展中发挥着作用。心脏移植患者患特定形式的冠状动脉疾病、心脏同种异体移植物血管病变 (CAV) 的风险增加，这在发病率和死亡率方面具有深远的影响。到目前为止，心外膜脂肪体积 (EFV) 在 CAV 发展中的作用仍然未知。因此，我们调查了 EFV 和 CAV 之间的关系以及供体/受体性别对 EFV 的影响。

方法

接受冠状动脉计算机断层扫描血管造影 (CCTA) 进行 CAV 筛查的成年心脏移植患者在 HT 后四年或更长时间被纳入。使用 CT 检查，我们量化了 EFV 和 CAV 的程度。序数和线性回归模型用于评估 EFV 与 CAV 的关联。

结果

总共包括 149 名患者（中位年龄 44.5 岁，36% 为女性）。HT 和 CT 扫描之间的中位时间为 11.0 (7.3–16.1) 年。分别有 85 名 (57%)、32 名 (22%)、14 名 (9%) 和 18 名 (12%) 患者出现 CAV 0、1、2 和 3 级。中位 EFV 为 208.4 (128.9–276.0) mL。较大的 EFV 与较高程度的 CAV 相关（CAV 0 级和 3 级的中位数分别为 164.7 至 290.6 mL，OR 5.23 (2.47–11.06)，p < 0.001）。无论供体性别如何，男性接受者的 EFV 明显高于女性接受者（分别为 232.7 mL 和 147.2 mL，p < 0.001）。EFV 的决定因素是受体性别、排斥次数、供体年龄、HT 和 CT 扫描之间的时间、受体 BMI 和糖尿病。