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| Clinical Implication Of Epicardial Fat Thickness Measured by MDCT As The Marker Of Left Ventricular Chamber Stiffness |
| 경희대학교 의과대학 부속병원 순환기 내과 |
| 황석재, 황승준, 이재범, 손일석, 김수중, 조진만, 김우식, 김명곤, 김종진, 배종화, 김권삼 |
Background Increased cardiac mass in obesity has been postulated to result from increased epicardial fat and fatty infiltration of the myocardium. But until now, it is unknown whether increased cardiac fat mass is related to elevated LV chamber stiffness before the onset of overt heart failure. So we evaluated the correlation between epicardial fat mass and LV chamber stiffness in obese patients with preserved systolic function. Method The study population comprised 96 consecutively enrolled obese patients(body mass index (BMI) ≥ 25) who underwent both 64 slice multidetector computed tomography(MDCT) and conventional coronary angiography with preserved LV systolic function (ejection fraction >45% by M mode). In MDCT images, epicardial fat thickness in short axis slices were measured in nine segments at each level (27 segments overall). LV chamber stiffness was calculated by the formula of KLV = (0.08/tdec)2 where tdec is deceleration time measured by transthoracic echocardiography. The severity of coronary artery disease was graded by Gensini scoring system based on conventional quantitative coronary angiography. Results The patients' age were 63±10 years old and the frequency of male patients was 47%. The average BMI were 28±2 and the proportion of diabetic patients was 30%. The average ejection fraction(EF) was 66±10%. Fifty three patients (54%) had coronary intervention for significant coronary artery disease. BMI showed significant positive correlation with epicardial fat thickness (r=0.363, p<0.001) and increased epicardial fat thickness was correlated with elevated LV chamber stiffness (r=0.267, p=0.008). But increased epicardial fat thickness was not correlated with LV wall mass(r=0.096, p=0.354). In multivariate analysis(covariates:LV mass, EF, epicardial fat thickness and Gensini score), epicardial fat thickness was independently correlated with LV chamber stiffness(r=0.267, p=0.004). Conclusion In obese patients with preserved LV systolic function, thickened epicardial fat measured by MDCT was associated with elevated LV chamber stiffness. This may indicate that obese patients’ heart is stiff and these patients have a definite subclinical LV diastolic dysfunction.
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