The Relationship Between Epicardial Adipose Tissue Thickness and Presence of Left Atrial Thrombus in Mitral Stenosis Patients

Abstract Objective: To examine the relationship between the left atrial (LA) thrombus presence and the epicardial adipose tissue (EAT) thickness. Methods: Three hundred and twelve consecutive rheumatic mitral valve stenosis (RMVS) patients with mitral valve area (MVA) < 2 cm2 were included in this cross-sectional study. Patients were divided into two groups, those with and those without LA thrombus. Routine biochemical analysis and electrocardiographic examinations were carried out. EAT was measured using transthoracic echocardiography. Results: LA thrombus was determined in 84 (26.9%) RMVS patients. In echocardiographic examinations, higher mean gradient and LA diameter as well as lower MVA were found in the group with LA thrombus (P<0.001). In this group, higher C-reactive protein (CRP) and EAT values were also determined (P<0.001). There was significant correlation between EAT and MVA, CRP, LA appendage peak flow velocity, LA anteroposterior diameter, and mean gradient (P<0.001). Higher EAT values were identified as independently associated with the presence of LA thrombus (odds ratio 59.5; 95% confidence interval 12.1-290.10; P<0.001). Conclusion: Transthoracic echocardiography, routinely used in patients with RMVS, can measure EAT to determine patients who are under risk for thrombus.

【摘要】
研究目的：探讨左心房（left atrial，LA）血栓形成与心外膜脂肪组织（epicardial adipose tissue，EAT）厚度之间的关联。
研究方法：本横断面研究纳入312例连续入选的风湿性二尖瓣狭窄（rheumatic mitral valve stenosis，RMVS）患者，所有患者的二尖瓣瓣口面积（mitral valve area，MVA）均小于2 cm²。根据是否合并LA血栓将患者分为两组。所有受试者均接受常规生化检验与心电图检查，并采用经胸超声心动图（transthoracic echocardiography）测量EAT厚度。
研究结果：84例（26.9%）RMVS患者合并LA血栓。超声心动图检查显示，LA血栓组患者的二尖瓣平均跨瓣梯度、左心房直径更高，而二尖瓣瓣口面积更低（均P<0.001）；该组患者的C反应蛋白（C-reactive protein，CRP）及EAT厚度亦更高（均P<0.001）。EAT厚度与二尖瓣瓣口面积、C反应蛋白、左心耳峰值血流速度、左心房前后径及二尖瓣平均跨瓣梯度均存在显著相关性（均P<0.001）。多因素分析显示，较高的EAT厚度是LA血栓形成的独立危险因素（比值比59.5；95%置信区间12.1~290.10；P<0.001）。
研究结论：常规应用于风湿性二尖瓣狭窄患者诊疗的经胸超声心动图，可通过测量EAT厚度识别血栓形成高风险人群。