Study On The Correlation Between Epicardial Fat Volume And The Degree Of Coronary Artery Disease And TCM Syndrome Types Of Coronary Artery Disease

Objective:To measure epicardial fat volume(EFV)by quantitative CT(QCT)and explore the correlation between epicardial fat volume and obstructive coronary artery disease;Through the study of relevant indexes of enrolled patients with coronary artery disease(CAD),to explore the distribution characteristics of TCM syndrome types of coronary artery disease and its relationship with epicardial fat volume and SYNTAX score,so as to provide prediction for the selection of clinical treatment schemes for coronary artery disease.Methods:This study collected patients who underwent coronary angiography and chest CT in the cardiovascular department and other clinical departments of Jiangsu Province Hospital of Chinese Medicine from October 2020 to August 2021.Patients with coronary artery stenosis≥50%were defined as coronary artery disease,and patients with coronary artery stenosis≥70%were defined as obstructive coronary artery disease.TCM syndrome types were divided into 8 syndrome types:heart blood stasis syndrome,qi stagnation and blood stasis syndrome,phlegm turbidity blocking syndrome,cold coagulation heart pulse syndrome,Qi deficiency and blood stasis syndrome,Qi and yin deficiency syndrome,heart and kidney yin deficiency syndrome and heart and kidney yang deficiency syndrome.A total of 203 patients were collected according to the inclusion and exclusion criteria,including 172 patients in the coronary artery disease group(degree of coronary stenosis≥ 50%)(including 141 patients with obstructive coronary artery disease(degree of coronary stenosis≥70%)and 31 patients in the no coronary artery disease group.Collect the general data and laboratory examination results of patients,detect the epicardial fat volume,SYNTAX score and other indicators,and analyze the correlation between epicardial fat volume and obstructive coronary artery disease,and the correlation between various indicators and the distribution of TCM syndromes of patients with coronary artery disease.Results:1.According to the results of coronary angiography,the subjects were divided into 141 cases of obstructive coronary artery disease group and 62 cases of no obstructive coronary artery disease group.The two groups had statistically significant differences in gender,history of diabetes,epicardial fat volume,intrathoracic fat volume,high-density lipoprotein cholesterol,apolipoprotein E,serum creatinine,uric acid and glycated hemoglobin(P<0.05).There was no significant difference in Age,BMI,smoking history,drinking history,family history,history of hypertension,total cholesterol,triglyceride,low density lipoprotein cholesterol,apolipoprotein A1,apolipoprotein B,lipoprotein(a),urea,fasting blood glucose,thoracic fat volume and subcutaneous fat volume(P>0.05).2.Multivariate logistic regression analysis showed that after adjusting for other risk factors,EFV[or=1.010,95%CI(1.000-1.020)]was an independent risk factor for obstructive coronary artery disease(P=0.039<0.05),indicating that the risk of obstructive coronary artery disease increased with the increase of EFV.3.The ROC curve showed that the AUC of EFV in predicting obstructive coronary artery disease was 0.614[95%CI(0.532,0.696)],and the sensitivity and specificity of EFV=248.75 cm3 in predicting obstructive coronary artery disease were 52%and 68%(P<0.05).4.Spearman correlation analysis showed that there was a significant positive correlation between EFV,SYNTAX score and the number of coronary lesions(r=0.157,P=0.026;r=0.231,P=0.002),and the EFV in the three vessel lesion group was significantly higher than that in the single vessel lesion group(P<0.001).5.According to the ROC curve,the area under the ROC curve(AUC)of EFV for predicting the number of coronary lesions was 0.681[95%CI(0.583,0.778)].Taking EFV=216.90 cm3 as the best critical value,the sensitivity and specificity for predicting the number of coronary lesions(single and three branches)were 100%and 2%(P<0.05).6.There was significant difference in EFV between different sexes(P<0.05).Spearman correlation analysis showed that EFV was significantly positively correlated with age,BMI,thoracic fat volume,intrathoracic fat volume,subcutaneous fat volume,triglyceride,high density lipoprotein cholesterol,apolipoprotein Al,urea,creatinine,uric acid,fasting blood glucose,glycated hemoglobin and high-sensitivity C reactive protein.The variables significantly correlated with EFV(P<0.05)were included in linear regression analysis.The results showed that EFV was only positively correlated with intrathoracic fat volume(P<0.001)7.The TCM syndrome types of CAD patients is mainly Qi deficiency and blood stasis syndrome,followed by qi stagnation and blood stasis syndrome,phlegm turbidity blocking syndrome,heart blood stasis syndrome,Qi and yin deficiency syndrome,heart and kidney yin deficiency syndrome,heart and kidney yang deficiency syndrome and cold coagulation heart pulse syndrome.8.Qi deficiency and blood stasis syndrome and qi stagnation and blood stasis syndrome accounted for the highest proportion in single coronary artery disease;Qi deficiency and blood stasis syndrome and phlegm turbidity blocking syndrome accounted for the highest proportion in double branch lesions;Qi deficiency and blood stasis syndrome and qi stagnation and blood stasis syndrome accounted for the highest proportion in the three branch lesions.There was no significant difference in the number of coronary artery lesions among TCM syndrome types(P>0.05).9.There were statistically significant differences in SYNTAX scores among different TCM syndrome types(heart blood stasis syndrome,qi stagnation and blood stasis syndrome,phlegm stagnation syndrome,Qi deficiency and blood stasis syndrome,Qi and yin deficiency syndrome)(P<0.05).The score order of each syndrome type:heart blood stasis syndrome>qi stagnation and blood stasis syndrome>Qi deficiency and blood stasis syndrome>Qi and yin deficiency syndrome>phlegm stagnation syndrome.There was no significant difference in the number of coronary artery lesions and other indicators among TCM syndrome types(P>0.05).On the basis of promoting blood circulation,removing blood stasis and resolving phlegm and detoxification,we should strengthen supplementing qi and nourishing blood,and regulate Qi,blood,Yin and Yang.Conclusion:1.EFV is an independent risk factor for obstructive coronary artery disease.With the increase of EFV,the risk of obstructive coronary artery disease increases.2.Quantitative calculation of EFV can predict the severity of coronary artery disease.The greater the EFV,the higher the syntax score,the more the number of coronary artery lesions,and the more serious the coronary artery lesions.3.EFV was significantly correlated with intrathoracic fat volume,but not with BMI,thoracic fat volume and subcutaneous fat volume.4.Qi deficiency and blood stasis syndrome is the most common TCM syndrome type of CAD patients,and the coronary artery lesions of heart blood stasis syndrome among all syndrome types is the most serious,suggesting that patients with heart blood stasis syndrome or with blood stasis are high-risk groups of CAD.