Excess epicardial fat volume (EFV) has been recently implicated in cardiovascular structural and functional abnormalities. It has been associated with abnormal microvascular stiffness (as reflected by radial artery waveform; C2), which may result in microvascular dysfunction and contribute to the atypical chest pain syndrome without obstructive coronary artery disease (CAD). Women have been statistically shown to present with atypical chest pain more often than men and specifically without obstructive CAD. The aim of this study is to assess whether excess EFV in female subjects is associated with significant microvascular dysfunction (i.e., C2), in subjects without obstructive CAD. We screened 596 asymptomatic subjects, ages 20–79, using the Early Cardiovascular Health Risk Scoring System (ECVHRS), which has been reported. Out of the 596 total subjects, 230 subjects had a CACS. Out of these 230 subjects, 77 subjects (45 females; 32 males) had a 0 CACS. The 45 females from this cohort were the subjects of this study, and they were further categorized into 3 groups: group 1 (normal EFV, non-obese female subjects; n=16), females with ECVHRS < 3 and ACC/AHA risk score < 5%; group 2 (n = 9), females with elevated EFV and no abdominal visceral obesity; and group 3 (n=20), females with elevated EFV and abdominal visceral obesity. The average EFV was determined to be 72±20 cm3 among group 1, which indicates the values for normal EFV. The results in group 2 indicate that excess EFV is contributing to the development of microvascular dysfunction, resulting in abnormal micro-arterial (C2) elasticity (p< 0.00001), increase in resting blood pressure (p =0.0001), an abnormal rise in blood pressure (BP) at rest and post-mild protocol exercise (PME) (p = < 0.00001), and abnormal increase in carotid intima-media thickness (CIMT) (p = 0.000164). Excess EFV appears to be not only a novel cardiovascular risk marker, but also the culprit for other cardiovascular risk markers. Based on these findings, elevated EFV may contribute to the development of the atypical chest pain syndrome in females without obstructive CAD. Additionally, EFV is emerging as a potential clinically relevant significant cardiovascular risk biomarker and may become a target to reduce cardiovascular morbidity and mortality.

中文翻译：

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女性心外膜脂肪量过多是微血管功能障碍的新风险标志物，这可能是非典型胸痛综合征的一个促成因素

心外膜脂肪体积过多 (EFV) 最近与心血管结构和功能异常有关。它与异常的微血管僵硬有关（如桡动脉波形所反映的；C2），这可能导致微血管功能障碍，并导致非典型胸痛综合征，而没有阻塞性冠状动脉疾病 (CAD)。统计表明，女性比男性更常出现非典型胸痛，特别是没有阻塞性 CAD。本研究的目的是评估女性受试者中过多的 EFV 是否与没有阻塞性 CAD 的受试者的显着微血管功能障碍（即 C2）相关。我们使用已报道的早期心血管健康风险评分系统 (ECVHRS) 筛选了 596 名年龄在 20-79 岁之间的无症状受试者。在 596 名受试者中，230 名受试者患有 CACS。在这 230 名受试者中，77 名受试者（45 名女性；32 名男性）的 CACS 为 0。该队列中的 45 名女性是本研究的受试者，她们进一步分为 3 组：第 1 组（正常 EFV，非肥胖女性受试者；n=16），ECVHRS < 3 和 ACC/AHA 风险评分的女性< 5%；第 2 组 (n = 9)，EFV 升高且无腹部内脏肥胖的女性；第 3 组 (n=20)，EFV 升高和腹部内脏肥胖的女性。第 1 组的平均 EFV 确定为 72±20 cm3，这表明 EFV 值正常。第 2 组的结果表明，过量的 EFV 导致微血管功能障碍的发展，导致微动脉 (C2) 弹性异常 (p<0.00001)，静息血压升高 (p =0.0001)，静息和轻度运动后 (PME) 时血压 (BP) 异常升高 (p = < 0.00001)，颈动脉内膜中层厚度 (CIMT) 异常增加 (p = 0.000164)。过量 EFV 似乎不仅是一种新的心血管风险标志物，也是其他心血管风险标志物的罪魁祸首。基于这些发现，升高的 EFV 可能导致无阻塞性 CAD 的女性出现非典型胸痛综合征。此外，EFV 正在成为一种潜在的临床相关的显着心血管风险生物标志物，并可能成为降低心血管发病率和死亡率的目标。过量 EFV 似乎不仅是一种新的心血管风险标志物，也是其他心血管风险标志物的罪魁祸首。基于这些发现，升高的 EFV 可能导致无阻塞性 CAD 的女性出现非典型胸痛综合征。此外，EFV 正在成为一种潜在的临床相关的显着心血管风险生物标志物，并可能成为降低心血管发病率和死亡率的目标。过量 EFV 似乎不仅是一种新的心血管风险标志物，也是其他心血管风险标志物的罪魁祸首。基于这些发现，升高的 EFV 可能导致无阻塞性 CAD 的女性出现非典型胸痛综合征。此外，EFV 正在成为一种潜在的临床相关的显着心血管风险生物标志物，并可能成为降低心血管发病率和死亡率的目标。