Genç bireylerde transtorasik ekokardiyografi ile ölçülen paraaortik yağ doku kalınlığının diyastolik fonksiyon üzerine etkisi

Öz

Amaç: Bu çalışmanın amacı, genç yaş grubunda transtorasik ekokardiyografi ile ölçülen paraaortik adipoz doku (PAT) kalınlığı ile sol ventrikül diyastolik fonksiyon parametreleri arasındaki ilişkinin değerlendirilmesidir. Gereç ve Yöntemler: Kesitsel olarak tasarlanan bu çalışmaya, kardiyoloji polikliniğine başvuran 18–55 yaş arası toplam 254 birey dahil edilmiştir. Katılımcılardan detaylı tıbbi geçmiş alınmış, vücut kütle indeksi (BMI), vücut yüzey alanı (BSA) ve rutin biyokimyasal testler kaydedilmiştir. Transtorasik ekokardiyografi kullanılarak ejeksiyon fraksiyonu, sol ventrikül kas kütle indeksi ve diyastolik fonksiyonlar değerlendirilmiştir. PAT kalınlığı, çıkan aortun sinotübüler bileşkesinin 2 cm üzerindeki hipoekoik boşluk olarak tanımlanmış ve ekokardiyografi ile milimetre cinsinden ölçülmüştür. İstatistiksel analizler için IBM SPSS programı kullanılmış, parametreler arasında korelasyon, univariate ve multivariate regresyon analizleri uygulanmıştır. Bulgular: Katılımcıların %27,1’inde (n=69) diyastolik disfonksiyon saptanmıştır. Diyastolik disfonksiyon grubunda yaş (p < 0,001), beden kitle indeksi (p = 0,005), vücut yüzey alanı (p = 0,043) ve PAT kalınlığı (9,09 ± 4,26 mm vs. 6,91 ± 4,57 mm; p = 0,003) anlamlı olarak daha yüksekti. Ayrıca bu grupta sol atriyum çapı (p = 0,016), aort çapı (p < 0,001), relatif duvar kalınlığı (p = 0,003) ve sol ventrikül kütle indeksi (p = 0,012) de anlamlı şekilde artmıştı. Univariate regresyon analizinde PAT (OR = 1,10; %95 GA: 1,03–1,19; p = 0,003), yaş (OR = 1,12; %95 GA: 1,05– 1,21; p < 0,001), hipertansiyon (OR = 2,78; %95 GA: 1,49–5,17; p = 0,001), BMI (OR = 1,08; %95 GA: 1,02–1,16; p = 0,009) ve RDW (OR = 1,15; %95 GA: 1,01–1,31; p = 0,032) diyastolik disfonksiyonla anlamlı ilişkiliydi. Ancak multivariate analizde yalnızca yaş bağımsız prediktör olarak kaldı (p = 0,045; OR = 1,089; %95 GA: 1,002–1,183). Korelasyon analizinde PAT, yaş (r = 0,41; p < 0,001), BMI (r = 0,33; p < 0,001), BSA (r = 0,37; p < 0,001), LA çapı (r = 0,34; p = 0,012), RWT (r = 0,33; p = 0,014) ve LVMI (r = 0,35; p = 0,009) ile pozitif korelasyon gösterirken, E/A oranı ile negatif korelasyon saptandı (r = –0,39; p < 0,001). Sonuç: Transtorasik ekokardiyografi ile ölçülebilen paraaortik adipoz doku kalınlığı, genç bireylerde diyastolik fonksiyon bozukluğu ile ilişkili bulunmuştur. Ancak PAT, yaş ve obezite gibi geleneksel risk faktörlerinden bağımsız bir prediktör değildir. Bu sonuçlar, aort çevresindeki adipoz dokunun diyastolik disfonksiyon patofizyolojisinde olası bir rolü olabileceğini ve subklinik dönemde risk belirteci olarak değerlendirilebileceğini düşündürmektedir.

Anahtar Kelimeler

• Paraaortik adipoz doku
• diyastolik disfonksiyon
• kalp yetmezliği
• korunmuş
• ekokardiyografi
• kardiyak remodelling

The effect of paraaortic fat tissue thickness measured by transthoracic echocardiography on diastolic function in young individuals

Öz

Aim: The aim of this study is to evaluate the relationship between paraaortic adipose tissue (PAT) thickness measured by transthoracic echocardiography and left ventricular diastolic function parameters in the young age group. Material and Methods: This cross-sectional study included a total of 254 individuals aged 18–55 who visited the cardiology outpatient clinic. Participants' detailed medical histories were obtained, and body mass index (BMI), body surface area (BSA), and routine biochemical tests were recorded. Ejection fraction, left ventricular mass index, and diastolic function were assessed using transthoracic echocardiography. PAT thickness was defined as a hypoechoic space 2 cm above the sinotubular junction of the ascending aorta and measured in millimetres using echocardiography. The IBM SPSS program was used for statistical analyses, and correlation, univariate, and multivariate regression analyses were performed between parameters. Results: Diastolic dysfunction was detected in 27.1% of participants (n=69). In the diastolic dysfunction group, age (p < 0.001), body mass index (p = 0.005), body surface area (p = 0.043), and PAT thickness (9.09 ± 4.26 mm vs. 6.91 ± 4.57 mm; p = 0.003) were significantly higher. Additionally, left atrial diameter (p = 0.016), aortic diameter (p < 0.001), relative wall thickness (p = 0.003), and left ventricular mass index (p = 0.012) were also significantly increased in this group. In univariate regression analysis, PAT (OR = 1.10; 95% CI: 1.03–1.19; p = 0.003), age (OR = 1.12; 95% CI: 1.05–1.21; p < 0.001), hypertension (OR = 2.78; 95% CI: 1.49–5.17; p = 0.001), BMI (OR = 1.08; 95% CI: 1.02–1.16; p = 0.009), and RDW (OR = 1.15; 95% CI: 1.01–1.31; p = 0.032) were significantly associated with diastolic dysfunction. However, in multivariate analysis, only age remained an independent predictor (p = 0.045; OR = 1.089; 95% CI: 1.002–1.183). In correlation analysis, PAT correlated with age (r = 0.41; p < 0.001), BMI (r = 0.33; p < 0.001), BSA (r = 0.37; p < 0.001), LA diameter (r = 0.34; p = 0.012), RWT (r = 0.33; p = 0.014), and LVMI (r = 0.35; p = 0.009), while a negative correlation was found with the E/A ratio (r = –0.39; p < 0.001). Conclusion: Para-aortic adipose tissue thickness, which can be measured by transthoracic echocardiography, has been found to be associated with diastolic dysfunction in young individuals. However, PAT is not an independent predictor independent of traditional risk factors such as age and obesity. These results suggest that adipose tissue around the aorta may play a role in the pathophysiology of diastolic dysfunction and may be considered a risk marker in the subclinical period.

Anahtar Kelimeler

• Para-aortic adipose tissue
• diastolic dysfunction
• echocardiography
• heart failure
• preserved
• cardiac remodelling

Kaynakça

1. Borlaug BA. The pathophysiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2014;11(9):507-515. https://doi.org/10.1038/nrcardio.2014.83
2. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251-259. https://doi.org/10.1056/NEJMoa052256
3. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277-314. https://doi.org/10.1016/j.echo.2016.01.011
4. Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004;350(19):1953-1959. https://doi.org/10.1056/NEJMoa032566
5. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med. 2005;2(10):536-543. https://doi.org/10.1038/ncpcardio0319
6. Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108(20):2460-2466. https://doi.org/10.1161/01.CIR.0000099542.57313.C5
7. Westermann D, Lindner D, Kasner M, Zietsch C, Savvatis K, Escher F, et al. Cardiac inflammation contributes to changes in the extracellular matrix in patients with heart failure and normal ejection fraction. Circ Heart Fail. 2011;4(1):44-52. https://doi.org/10.1161/CIRCHEARTFAILURE.109.931451
8. Mahabadi AA, Berg MH, Lehmann N, Kälsch H, Bauer M, Kara K, et al. Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol. 2013;61(13):1388-1395. https://doi.org/10.1016/j.jacc.2012.11.062

9. Şengül C, Özveren O. Epicardial adipose tissue: a review of physiology, pathophysiology, and clinical applications. Anadolu Kardiyol Derg. 2013;13(3):261-265. https://doi.org/10.5152/akd.2013.075
10. Man AWC, Zhou Y, Xia N, Li H. Perivascular Adipose Tissue as a Target for Antioxidant Therapy for Cardiovascular Complications. Antioxidants (Basel). 2020;9(7). https://doi.org/10.3390/antiox9070574
11. Antoniades C, Tousoulis D, Vavlukis M, Fleming I, Duncker DJ, Eringa E, et al. Perivascular adipose tissue as a source of therapeutic targets and clinical biomarkers. Eur Heart J. 2023;44(38):3827-3844. https://doi.org/10.1093/eurheartj/ehad484
12. Davies PF. Hemodynamic shear stress and the endothelium in cardiovascular pathophysiology. Nat Clin Pract Cardiovasc Med. 2009;6(1):16-26. https://doi.org/10.1038/ncpcardio1397
13. Çakan F, Adar A, Akıncı S, Köktürk U, Akbay E, Önalan O. Novel predictor for metabolic syndrome: Para-aortic adipose tissue. Am J Med Sci. 2025;369(4):472-478. https://doi.org/10.1016/j.amjms.2024.11.008
14. Falconi CA, Junho C, Fogaça-Ruiz F, Vernier ICS, da Cunha RS, Stinghen AEM, et al. Uremic Toxins: An Alarming Danger Concerning the Cardiovascular System. Front Physiol. 2021;12:686249. https://doi.org/10.3389/fphys.2021.686249
15. Kaesler N, Babler A, Floege J, Kramann R. Cardiac Remodeling in Chronic Kidney Disease. Toxins (Basel). 2020;12(3): 161. https://doi.org/10.3390/toxins12030161
16. Xanthopoulos A, Giamouzis G, Dimos A, Skoularigki E, Starling RC, Skoularigis J, et al. Red Blood Cell Distribution Width in Heart Failure: Pathophysiology, Prognostic Role, Controversies and Dilemmas. J Clin Med. 2022;11(7). https://doi.org/10.3390/jcm11071951
17. Çakan F, Sunal AS, Adar A, Onalan O. Aortic Arch Calcification Observed on Chest X-Ray May Serve as an Independent Predictor for Recurrent Stroke. Arq Bras Cardiol. 2024;121(7):e20230805. https://doi.org/10.36660/abc.20230805i
18. Ćatić J, Jurin I, Lucijanić M, Jerkić H, Blažeković R. High red cell distribution width at the time of ST segment elevation myocardial infarction is better at predicting diastolic than systolic left ventricular dysfunction: A single-center prospective cohort study. Medicine (Baltimore). 2018;97(18):e0601. https://doi.org/10.1097/MD.0000000000010601
19. Alattar FT, Imran NB, Patel P, Usmani S, Shamoon FE. Red cell distribution width (RDW) correlates with markers of diastolic dysfunction in patients with impaired left ventricular systolic function. Int J Cardiol Heart Vasc. 2016;10:13-16. https://doi.org/10.1016/j.ijcha.2015.08.001
20. Chen YL, Zhao ZW, Li SM, Guo YZ. Value of red blood cell distribution width in prediction of diastolic dysfunction in cirrhotic cardiomyopathy. World J Gastroenterol. 2023;29(15):2322-2335. https://doi.org/10.3748/wjg.v29.i15.2322