The Clinical Value Of Local EAT Thickness And NLR In The Evaluation Of Coronary Artery Disease And Its Severity

BackgroundsAtherosclerosis gives rise to coronary artery disease(CAD)is the most important component of cardiovascular disease and the leading cause of mortality and morbidity all over the world.The risk factors of CAD include obesity,hypertension,diabetes,metabolic syndrome,smoking and so on.The formation of coronary atherosclerotic plaque is the main pathological mechanism of CAD.Through a slowly progression of atherosclerotic lesions formation and the luminal stenosis of coronary arteries,upon unstable plaque rupture,erosion,vasospasm,thrombosis,these all kinds of cardiovascular disease which manifest as acute coronary syndrome(ACS),myocardial infarction or stroke.Atherosclerosis has long been considered as an inflammatory disease,which involving in a sustained inflammatory response.The inflammatory response has been suggested to be involved in all stages of atherosclerotic plaque formation,from initiation to progression,and ultimately to play an important role in the thrombotic complications of atherosclerosis.Many studies have linked the long-term cardiovascular risk in healthy people and CAD patients to increased level of inflammatory cytokines such as IL-6 and TNF-? and hypersensitive C-reactive protein(hs-CRP)in the blood circulation.Systemic inflammatory response and adipokines produced by adipose tissue are thought to play an important role in the process of atherogenesis.Epicardial adipose tissue is not only an ectopic fat deposit,but also a metabolically active endocrine organ.The inflammatory cytokines which are secreted by EAT play an important role in the inflammatory process of atherosclerosis,promoting and aggravating the inflammatory load inside and around the atherosclerotic plaque.Neutrophil to lymphocyte ratio is a low-cost,easy to abtain,widely used inflammatory marker,also it is an important marker of cardiovascular disease and can make risk stratification in patients with cardiovascular diseases.Neutrophil to lymphocyte ratio has been reported to be associated with arterial stiffness,coronary artery calcification score,and the progression of atherosclerosis.Neutrophil to lymphocyte ratio is not only an independent predictor of prognosis for stable coronary artery disease,but also a predictor of short-term and long-term mortality in patients with acute coronary syndrome.Given cardiac magnetic resonance imaging has a plenty of imaging sequences,excellent soft tissue contrast,large field of view,multi-angle scanning,it can fully evaluate cardiac structure,function,myocardial perfusion,myocardial viability and so on.Cardiac magnetic resonance imaging is considered as the one-stop shop for the evalution of cardiovascular disease.In addition,MRI is also recognized as the gold standard for measuring adipose tissue.Excellent spatial resolution and soft tissue contrast make it easy to distinguish between epicardial adipose tissue and pericardial adipose tissue,and stand out from many imaging examinations.The SYNTAX score was based on anatomy and was originally used to assess the complexity of coronary anatomy objectively.Later,more and more studys are using SYNTAX score to predict the short-term and long-term main cardiovascular adverse events and clinical outcomes of choosing different procedures such as primary PCI or CABG in patients with acute myocardial infarction,left main coronary disease,and three-vessel coronary disease.ObjectiveTo explore the clinical value of local epicardial adipose tissue thickness combine with neutrophil to lymphocyte ratio to predict coronary atherosclerotic events in patients with stable coronary heart disease,and to further evaluate the relationship between the two factors and the severity degree of coronary atherosclerosis.MethodsWe retrospectively analysed the clinical and laboratory data of 292 patients who were diagnosed with coronary artery disease from January 1,2018 to June 1,2018,in the Department of Cardiology,First Affiliated Hospital of Zhengzhou University.When patients at admission,we collected the general clinical profile such as vital signs,height and weight of the patients,and blood sampling for examining of a complete blood count,liver and kidney function,blood lipid profile,blood glucose,glycosylated hemoglobin and other indicators in the early morning after fasting for 8 hours.All patients underwent percutaneous coronary angiography and cardiac magnetic resonance imaging.Based on CAG results,the patients were divided into 2 groups:non-CAD group(n=111)and CAD group(n=181).The differences in clinical data,blood biochemical parameters and local epicardial adipose tissue thickness were compared between the two groups.The SYNTAX score was used to evaluate the severity of coronary artery disease.Logistic regression analysis was used to correct the influence of confounding factors on the occurrence of coronary artery disease,and then to construct a disease prediction model.Drawing ROC curves to evaluate the independent and combined predictive value of local EAT thickness and NLR in the diagnosis of coronary artery disease.We use Pearson correlation analysis to evaluate the relationship between local EAT thickness,NLR level and SYNTAX score.Results(1)General clinical and biochemical data comparison between CAD group and non-CAD group : Compared with Non-CAD group,CAD group has higher levels of age,hypertension,diabetes,hyperlipidemia,smoking history,local EAT thickness and NLR,while the HDL-C level is lower in CAD group(P<0.05).(2)Logistic regression analysis: Univariate logistic regression analysis showed that age,hypertension,diabetes,smoking,and LDL-C are risk factors for coronary artery disease,while HDL-C is a protective factor.Local EAT thickness and NLR level may be risk factors for coronary artery disease.Multivariate logistic regression analysis showed that after adjusting for other confounding variables,EAT thickness in the left atrioventricular groove and NLR level are positive predictors for coronary artery disease.(3)ROC curves of EAT thickness in the left atrioventricular groove and NLR in the prediction of CAD: The AUC of the independent and combined predictive value of local EAT thickness and NLR in the diagnosis of coronary artery disease are 0.720,0.801,0.825,respectively(P<0.001).The later model has a better predictive value.(4)Pearson correlation analysis among local EAT thickness,NLR and SYNTAX score: In the CAD group,the EAT thickness in the left atrioventricular groove and NLR are significantly correlated with the SYNTAX score(r=0.477,r=0.439,P<0.001,respectively);There is no significant correlation between EAT thickness in the right atrioventricular groove,anterior interventricular groove and the SYNTAX score(P>0.05).Subgroup analysis was performed in accordance with the quartile of EAT thickness in the left atrioventricular groove,with the increase of the EAT thickness in the left atrioventricular groove,the level of NLR and SYNTAX score increased gradually,the differences among the 4 subgroups were significant(P<0.001).ConclusionsThe combination of EAT thickness in the left atrioventricular groove and NLR levels has highly predictive value in the diagnosis of CAD,which are positively correlated with the severity degree of coronary atherosclerotic lesions.