The Relation Between Echocardiographic Epicardial Fat Thickness and CHA2DS2-VASc Score in Patients with Sinus Rhythm

Abstract Objective: To evaluate the predictive value of epicardial fat thickness (EFT) in CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) score risk groups. Methods: A total of 158 consecutive patients (75 females, 83 males, mean age 70.8±6.3 years) admitted routinely for cardiologic control were divided into two groups according to their CHA2DS2-VASc scores (scores 0 and 1 were regarded as low risk, and score ≥2 as high risk). One hundred twenty-five of 158 patients had a high-risk score. Results: Mean EFT was significantly higher in the high-risk group than in the low-risk group (4.34±0.62 vs. 5.37±1.0; P<0.001). EFT was positively correlated with CHA2DS2-VASc score (r=0.577, P<0.001). According to receiver operating characteristics (ROC) analysis, EFT value of 4.4 mm was found to be predictive of high risk in CHA2DS2-VASc score with 80% of sensitivity and 79% of specificity (C-statistic = 0.875, P<0.001, 95% confidence interval [CI] = 0.76-0.90). And according to multivariate logistic regression analysis, EFT was an independent predictor of high thromboembolic risk in terms of CHA2DS2-VASc score. Conclusion: Our findings suggest that echocardiographic EFT measurement could provide additional information on assessing cardiovascular risks, such as thromboembolic events, and individuals with increased EFT should receive more attention to reduce unfavorable cardiovascular risk factors and the development of future cardiovascular events.

摘要 目的：评估心外膜脂肪厚度（epicardial fat thickness, EFT）对CHA₂DS₂-VASc（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往卒中或短暂性脑缺血发作、血管疾病、年龄65~74岁、性别）评分风险分层的预测价值。方法：连续纳入158例行常规心脏随访的患者（其中女性75例，男性83例，平均年龄70.8±6.3岁），依据CHA₂DS₂-VASc评分分为两组：评分0~1分者为低危组，评分≥2分者为高危组，158例患者中共有125例属于高危评分人群。结果：高危组患者的平均EFT显著高于低危组（5.37±1.0 vs 4.34±0.62，P<0.001）；EFT与CHA₂DS₂-VASc评分呈正相关（r=0.577，P<0.001）。经受试者工作特征（receiver operating characteristics, ROC）曲线分析，当EFT取值为4.4 mm时，可预测CHA₂DS₂-VASc评分高危人群，灵敏度为80%，特异度为79%（C统计量=0.875，P<0.001，95%置信区间（confidence interval, CI）=0.76~0.90）。多因素logistic回归分析显示，EFT是CHA₂DS₂-VASc评分相关高血栓栓塞风险的独立预测因子。结论：本研究结果表明，超声心动图检测EFT可为血栓栓塞事件等心血管风险评估提供额外参考信息，EFT升高的个体应受到更多关注，以管控不良心血管危险因素，降低未来心血管事件的发生风险。