射血分数保留型心力衰竭的心脏磁共振特征分析
该回顾性研究纳入117例HFpEF患者、65例健康对照和62例高危个体，用CMR量化心外膜脂肪并分析其与左室功能及预后的关联。EATi在对照组、高危组和HFpEF组间递增，且与LV-GLS独立相关并可区分各组；随访31个月，较高EATi与复合终点风险增加独立相关。
要点
- EATi在对照组、高危组、HFpEF组中逐级升高，中位数分别为20.32、31.98、48.21 mL/m2。
- EATi区分对照组与高危个体的AUC为0.818（ cutoff 23.96 mL/m2），区分高危与HFpEF的AUC为0.784（cutoff 45.90 mL/m2）。
- EATi每增加1 mL/m2，复合终点风险HR=1.05（95%CI 1.02-1.07，P=0.0002）。
核心结论
- CMR量化的EAT体积与HFpEF严重程度强相关，并能预测不良结局，在常规指标之外提供增量诊断和预后价值。
研究设计与样本
- 回顾性研究，纳入117例HFpEF患者、65例健康对照和62例高危个体，均行CMR检查。
- 随访队列n=228（HFpEF和高危参与者），主要终点为心衰再入院或全因死亡。
- 使用CVI42软件测量EAT体积和左室应变。
关键影像表现/征象
- EATi在对照组、高危组和HFpEF组中逐级升高，中位数分别为20.32、31.98和48.21 mL/m2（P<0.001）。
- 包含三个应变参数的多变量logistic回归模型中，EATi和LV-GLS与HFpEF独立相关。
诊断标准与关键数值
- EATi区分对照组与高危个体：AUC=0.818，cutoff 23.96 mL/m2。
- EATi区分高危个体与HFpEF患者：AUC=0.784，cutoff 45.90 mL/m2。
- 随访中位31个月，EATi每增加1 mL/m2，复合终点风险HR=1.05（95%CI 1.02-1.07，P=0.0002）。
临床应用与阅片要点
- 在HFpEF评估中可关注EATi量化值，结合LV-GLS等应变参数综合判断。
- EATi升高可能提示HFpEF风险增加及预后不良，可作为风险分层参考。
局限性
- 回顾性研究设计。
- 结论需在前瞻性研究中验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
AIM: The rising prevalence of heart failure with preserved ejection fraction (HFpEF) underscores the importance of epicardial adipose tissue (EAT). This study employs cardiac magnetic resonance (CMR) to quantify EAT volume and investigate its association with left ventricular function and patient prognosis, aiming to inform clinical strategies.
MATERIALS AND METHODS: We retrospectively analysed 117 HFpEF patients, 65 healthy controls, and 62 high-risk individuals using CMR. A follow-up cohort (n = 228), consisting of HFpEF and high-risk participants, was assessed for the primary endpoint of heart failure readmission or all-cause death. EAT volume and left ventricular strain were measured using CVI42 software.
RESULTS: The epicardial adipose tissue index (EATi) increased progressively across control, high-risk, and HFpEF groups (median: 20.32, 31.98, and 48.21 mL/m2, P < 0.001). In a multivariable logistic regression model including three strain parameters, EATi and left ventricular global longitudinal strain (LV-GLS) were independently associated with HFpEF. EATi effectively discriminated control from high-risk individuals (area under the curve [AUC] = 0.818, cutoff 23.96 mL/m2) and high-risk from HFpEF patients (AUC = 0.784, cutoff 45.90 mL/m2). Over a median follow-up of 31 months, higher EATi was independently associated with an increased risk of the composite endpoint (hazard ratio [HR] = 1.05 per mL/m2 increase, 95% confidence interval [CI]: 1.02-1.07, P = 0.0002).
CONCLUSION: CMR-quantified EAT volume is strongly associated with HFpEF severity and predicts adverse outcomes, providing incremental diagnostic and prognostic value beyond conventional metrics. EAT represents a promising imaging biomarker for risk stratification in HFpEF, warranting validation in prospective studies.
引用
- Zhang Y, Li Y, Yang X, et al. Analysis of cardiac magnetic resonance characteristics in patients with ejection fraction preserved heart failure. Clin Radiol. 2026. PMID: 42161171. doi:10.1016/j.crad.2026.107348
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。