BACKGROUND Increased epicardial adipose tissue (EAT) has adverse effects in cardiovascular diseases, independent of body mass index (BMI). Estrogen levels may impact EAT accumulation. Little is known about the predictors and potential impact of EAT in PAH. RESEARCH QUESTION Is EAT associated with estrogen levels, disease severity, and mortality in PAH? STUDY DESIGN AND METHODS We conducted a retrospective cohort study of patients with PAH enrolled in the Penn Pulmonary Hypertension registry and used chest computed tomography (CT) scans to quantify EAT. We also measured serum estrone and estradiol levels. RESULTS 221 patients were included in the analysis, with median follow-up of 88 months. Mean age was 55.1 years, 74.7% were female, mean BMI was 27.20 kg/m2, and the most common PAH etiology was connective tissue disease-associated PAH (43.0%) followed by idiopathic/heritable PAH (35.3%). Median EAT volume was 52.1 mL/m2. Of the 102 patients with a follow-up chest CT, EAT increased over time in 74 (71.8%). High EAT volume (HR 2.62, 95% CI 1.62-4.24, p<0.001) and greater accumulation of EAT over time (HR 1.09, 95% CI 1.01 - 1.17, p=0.03) were both independently associated with worse survival. Patients with high EAT volume had lower serum estrone (13.70 versus 30.60 pg/mL, p=0.009) and estradiol (6.05 versus 19.40 pg/mL, p=0.002) levels compared to those with low EAT volume. INTERPRETATION In patients with PAH, high EAT and a greater rate of accumulation of EAT volume were independently associated with worse survival. Higher EAT volume was also associated with lower estrogen levels. The association of EAT volume with survival was independent of BMI and disease severity, suggesting that EAT may be a marker for a unique PAH phenotype. Future research should investigate the role of EAT-modifying therapies in PAH and consider incorporating EAT into PAH risk models.

中文翻译：

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心外膜脂肪组织是肺动脉高压死亡的独立危险因素。


背景 心外膜脂肪组织 （EAT） 增加对心血管疾病有不利影响，与体重指数 （BMI） 无关。雌激素水平可能影响 EAT 积累。关于 EAT 对 PAH 的预测因子和潜在影响知之甚少。研究问题 EAT 与 PAH 的雌激素水平、疾病严重程度和死亡率是否相关？研究设计和方法 我们对 Penn 肺动脉高压登记处登记的 PAH 患者进行了一项回顾性队列研究，并使用胸部计算机断层扫描 （CT） 扫描来量化 EAT。我们还测量了血清雌酮和雌二醇水平。结果 纳入 221 例患者，中位随访 88 个月。平均年龄为 55.1 岁，74.7% 为女性，平均 BMI 为 27.20 kg/m2，最常见的 PAH 病因是结缔组织病相关 PAH （43.0%），其次是特发性/遗传性 PAH （35.3%）。中位 EAT 体积为 52.1 mL/m2。在 102 例接受随访胸部 CT 的患者中，74 例 （71.8%） 的 EAT 随着时间的推移而增加。高 EAT 量 （HR 2.62,95% CI 1.62-4.24，p<0.001） 和 EAT 随时间积累的增加 （HR 1.09,95% CI 1.01 - 1.17，p=0.03） 均与较差的生存率独立相关。与低 EAT 体积患者相比，高 EAT 体积患者的血清雌酮 （13.70 vs 30.60 pg/mL，p=0.009） 和雌二醇 （6.05 vs 19.40 pg/mL，p=0.002） 水平较低。解释在 PAH 患者中，高 EAT 和较大的 EAT 体积积累率与较差的生存率独立相关。较高的 EAT 体积也与较低的雌激素水平相关。EAT 体积与生存率的相关性与 BMI 和疾病严重程度无关，表明 EAT 可能是独特 PAH 表型的标志物。 未来的研究应调查 EAT 修饰疗法在 PAH 中的作用，并考虑将 EAT 纳入 PAH 风险模型。