Abstract：
BACKGROUND: Patients with myocardial ischemia without obstructive coronary artery disease often have coronary microvascular dysfunction (CMD) and associated increased risk of cardiovascular (CV) events and anginal hospitalizations. Epicardial adipose tissue (EAT) covers much of the myocardium and coronary arteries and when dysfunctional, secretes proinflammatory cytokines and is associated with CV events. While oxidative stress and systemic inflammation are associated with CMD, the relationship between EAT and CMD in women is not well known.
METHODS: Women diagnosed with CMD (n = 21) who underwent coronary computed tomography with coronary artery calcium (CAC) scoring were compared to a reference group (RG) of women referred for CAC screening for preventive risk assessment (n = 181). EAT attenuation (Hounsfield units (HU)) was measured adjacent to the proximal right coronary artery, along with subcutaneous adipose tissue (SCAT). Two-sample t-tests with unequal variances were utilized.
RESULTS: Mean age of the CMD group was 56 ± 8 years and body mass index (BMI) was 31.6 ± 6.8 kg/m2. CV risk factors in the CMD group were prevalent: 67 % hypertension, 44 % hyperlipidemia, and 33 % diabetes. Both CMD and RG had similar CAC score (25.86 ± 59.54 vs. 24.17 ± 104.6; p = 0.21. In the CMD group, 67 % had a CAC of 0. Minimal atherosclerosis (CAD-RADS 1) was present in 76 % of women with CMD. The CMD group had lower EAT attenuation than RG (-103.3 ± 6.33 HU vs. -97.9 ± 8.3 HU, p = 0.009, respectively). There were no differences in SCAT attenuation. Hypertension, smoking history, age, BMI, and CAC score did not correlate with EAT in either of the groups.
CONCLUSIONS: Women with CMD have decreased EAT attenuation compared to RG women. EAT-mediated inflammation and changes in vascular tone may be a mechanistic contributor to abnormal microvascular reactivity. Clinical trials testing therapeutic strategies to decrease EAT may be warranted in the management of CMD.
METHODS: Women diagnosed with CMD (n = 21) who underwent coronary computed tomography with coronary artery calcium (CAC) scoring were compared to a reference group (RG) of women referred for CAC screening for preventive risk assessment (n = 181). EAT attenuation (Hounsfield units (HU)) was measured adjacent to the proximal right coronary artery, along with subcutaneous adipose tissue (SCAT). Two-sample t-tests with unequal variances were utilized.
RESULTS: Mean age of the CMD group was 56 ± 8 years and body mass index (BMI) was 31.6 ± 6.8 kg/m2. CV risk factors in the CMD group were prevalent: 67 % hypertension, 44 % hyperlipidemia, and 33 % diabetes. Both CMD and RG had similar CAC score (25.86 ± 59.54 vs. 24.17 ± 104.6; p = 0.21. In the CMD group, 67 % had a CAC of 0. Minimal atherosclerosis (CAD-RADS 1) was present in 76 % of women with CMD. The CMD group had lower EAT attenuation than RG (-103.3 ± 6.33 HU vs. -97.9 ± 8.3 HU, p = 0.009, respectively). There were no differences in SCAT attenuation. Hypertension, smoking history, age, BMI, and CAC score did not correlate with EAT in either of the groups.
CONCLUSIONS: Women with CMD have decreased EAT attenuation compared to RG women. EAT-mediated inflammation and changes in vascular tone may be a mechanistic contributor to abnormal microvascular reactivity. Clinical trials testing therapeutic strategies to decrease EAT may be warranted in the management of CMD.
摘要：
背景：无阻塞性冠状动脉疾病的心肌缺血患者通常有冠状动脉微血管功能障碍（CMD），并增加心血管事件（CV）和心绞痛住院的风险。心外膜脂肪组织（EAT）覆盖大部分心肌和冠状动脉，当功能失调时，分泌促炎细胞因子并与CV事件相关。虽然氧化应激和全身性炎症与CMD有关,女性EAT和CMD之间的关系尚不清楚。
方法：将诊断为CMD的女性（n=21）进行冠状动脉计算机断层扫描并进行冠状动脉钙（CAC）评分，与参考组（RG）进行CAC筛查以进行预防性风险评估的女性（n=181）进行比较。EAT衰减（Hounsfield单位（HU））测量邻近近端右冠状动脉，以及皮下脂肪组织（SCAT）。采用不等方差的双样本t检验。
结果：CMD组的平均年龄为56±8岁，体重指数（BMI）为31.6±6.8kg/m2。CMD组的CV危险因素很普遍：67%的高血压，44%的高脂血症,33%的糖尿病。CMD和RG的CAC评分相似（25.86±59.54vs.24.17±104.6；p=0.21。在CMD组中,67%有一个CAC为0。最小动脉粥样硬化（CAD-RADS1）存在于76％的CMD女性中。CMD组的EAT衰减低于RG（-103.3±6.33HUvs.-97.9±8.3HU，分别为p=0.009)。SCAT衰减没有差异。高血压,吸烟史,年龄,BMI,两组的CAC评分与EAT均无相关性。
结论：与RG女性相比，CMD女性的EAT衰减降低。EAT介导的炎症和血管张力的变化可能是异常微血管反应性的机制因素。在CMD的管理中，可能需要测试降低EAT的治疗策略的临床试验。
方法：将诊断为CMD的女性（n=21）进行冠状动脉计算机断层扫描并进行冠状动脉钙（CAC）评分，与参考组（RG）进行CAC筛查以进行预防性风险评估的女性（n=181）进行比较。EAT衰减（Hounsfield单位（HU））测量邻近近端右冠状动脉，以及皮下脂肪组织（SCAT）。采用不等方差的双样本t检验。
结果：CMD组的平均年龄为56±8岁，体重指数（BMI）为31.6±6.8kg/m2。CMD组的CV危险因素很普遍：67%的高血压，44%的高脂血症,33%的糖尿病。CMD和RG的CAC评分相似（25.86±59.54vs.24.17±104.6；p=0.21。在CMD组中,67%有一个CAC为0。最小动脉粥样硬化（CAD-RADS1）存在于76％的CMD女性中。CMD组的EAT衰减低于RG（-103.3±6.33HUvs.-97.9±8.3HU，分别为p=0.009)。SCAT衰减没有差异。高血压,吸烟史,年龄,BMI,两组的CAC评分与EAT均无相关性。
结论：与RG女性相比，CMD女性的EAT衰减降低。EAT介导的炎症和血管张力的变化可能是异常微血管反应性的机制因素。在CMD的管理中，可能需要测试降低EAT的治疗策略的临床试验。
