Impacto clínico de la adiposidad visceral en la mortalidad a largo plazo de pacientes sometidos a revascularización coronaria

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia Pub Date : 2024-11-19 DOI:10.1016/j.recesp.2024.09.004

Jinhwan Jo , Seung Hun Lee , Jeong Hoon Yang , Sung Mok Kim , Ki Hong Choi , Young Bin Song , Dong Seop Jeong , Joo Myung Lee , Taek Kyu Park , Joo-Yong Hahn , Seung-Hyuk Choi , Su Ryeun Chung , Yang Hyun Cho , Kiick Sung , Wook Sung Kim , Hyeon-Cheol Gwon , Young Tak Lee

{"title":"Impacto clínico de la adiposidad visceral en la mortalidad a largo plazo de pacientes sometidos a revascularización coronaria","authors":"Jinhwan Jo , Seung Hun Lee , Jeong Hoon Yang , Sung Mok Kim , Ki Hong Choi , Young Bin Song , Dong Seop Jeong , Joo Myung Lee , Taek Kyu Park , Joo-Yong Hahn , Seung-Hyuk Choi , Su Ryeun Chung , Yang Hyun Cho , Kiick Sung , Wook Sung Kim , Hyeon-Cheol Gwon , Young Tak Lee","doi":"10.1016/j.recesp.2024.09.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat.</div></div><div><h3>Methods</h3><div>A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm<sup>2</sup>)/height<sup>2</sup> (m<sup>2</sup>) at the L3 level. The primary outcome was all-cause mortality during follow-up.</div></div><div><h3>Results</h3><div>Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%<span>C</span>I, 0.91-0.97; <em>P</em>  <.001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; <em>P</em>  <!-->.001). Similar results were obtained after inverse probability treatment-weighting analysis.</div></div><div><h3>Conclusions</h3><div>Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 5","pages":"Pages 437-446"},"PeriodicalIF":5.9000,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista espanola de cardiologia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0300893224003877","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction and objectives

Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat.

Methods

A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm²)/height² (m²) at the L3 level. The primary outcome was all-cause mortality during follow-up.

Results

Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P < .001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P < .001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; P < .001). Similar results were obtained after inverse probability treatment-weighting analysis.

Conclusions

Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG.

查看原文本刊更多论文

内脏肥胖对冠状动脉再充血患者长期死亡率的临床影响

虽然在一般人群中，内脏性肥胖会增加心血管风险，但在危重患者中也有肥胖悖论的报道。然而，其在冠状动脉旁路移植术（CABG）患者中预后作用的证据有限。本研究利用基于计算机断层扫描的内脏脂肪测量评估了接受冠脉搭桥患者内脏脂肪的预后意义。方法对2007 - 2017年接受CABG治疗的2810例患者进行分析。根据内脏脂肪面积指数（VFAI）分位数将研究人群分为3组。VFAI计算为L3水平的内脏脂肪面积(cm2)/高度2 （m2）。主要结局为随访期间的全因死亡率。结果低VFAI组（最低分位数）的患者比高VFAI组（最高分位数）的患者更年轻，体重指数更低，皮下脂肪更少。在中位8.7年的随访中，限制性三次样条曲线分析显示，VFAI与死亡风险显著相关(HR为0.94 / 10；95%置信区间,0.91 - -0.97;P & lt;措施)。低VFAI组患者的长期死亡率高于中、高VFAI组(T1 36.1%, T2 27.2%, T3 29.1%；T1 vs T2；调整后的HR为1.36；95%置信区间,1.15 - -1.61;P & lt;措施;T1 vs T3；调整后的HR为1.37；95%置信区间,1.16 - -1.62;P & lt;措施)。反概率处理-加权分析得到了相似的结果。结论：慢性内脏脂肪化与冠脉搭桥患者长期死亡风险增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Revista espanola de cardiologia 医学-心血管系统

CiteScore

4.20

自引率

13.60%

发文量

257

审稿时长

28 days

期刊介绍： Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.