Body Composition, Coronary Microvascular Dysfunction, and Future Risk of Cardiovascular Events Including Heart Failure

doi:10.1016/j.jcmg.2023.07.014

Heart failure & cardiomyopathiesCohort study

Body Composition, Coronary Microvascular Dysfunction, and Future Risk of Cardiovascular Events Including Heart Failure

JACC Cardiovasc ImagingPublished 27 Sep 2023

Prospective cohort study
consecutive patients
deep learning body composition analysis

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Authors' conclusion

In a predominantly female cohort of patients without flow-limiting coronary artery disease, deficient muscularity, not excess adiposity, was independently associated with CMD and future adverse outcomes, especially heart failure.

Study context

Population: Patients referred for evaluation of CAD with normal perfusion and preserved LVEF on cardiac stress PET
Participants: 400 patients

Exposure: Body composition and coronary flow reserve (CFR) vs coronary microvascular dysfunction (CMD) and adverse events
Outcome: Major adverse events, including death and hospitalization for MI or HF
Follow-up: Median 6.0 years

Main finding

As reported in the abstract

Major adverse events

adjusted

Hazard ratio (95% CI)P value

per −1 U CFR

1.83(1.25–2.68)

P < 0.002

per −10 cm²/m² SM index

1.53(1.20–1.96)

P < 0.002

Each row per its own increment, as printed

Observational data: associations, not effects.

Further findings

Outcome	Lower ←→ Higher	Estimate	P value
HF hospitalization — per −1 U CFR		HR 2.36 (95% CI 1.31–4.24)	P < 0.004
HF hospitalization — per −10 cm²/m² SM index		HR 1.87 (95% CI 1.30–2.69)	P < 0.004
CMD (CFR <2) · adjusted		OR 1.38 (95% CI 1.08–1.75)	P < 0.01
	0.20.5125Ratio (log scale)

CMD (CFR <2)

Increased subcutaneous adipose tissue (SAT) or visceral adipose tissue (VAT) not significantly associated with CMD

Interaction CFR × skeletal muscle (SM) on adverse events

CMD with sarcopenia: highest rate of adverse events, especially young, female, obese patients: all P < 0.005

interaction adjusted P = 0.026

Obese (body mass index (BMI) 30.0-68.4 kg/m²) vs nonobese

Higher SAT, VAT and SM, lower CFR with obesity: all P < 0.001

Original publication

Body Composition, Coronary Microvascular Dysfunction, and Future Risk of Cardiovascular Events Including Heart Failure. JACC Cardiovasc Imaging. Published 27 September 2023. doi:10.1016/j.jcmg.2023.07.014

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Summarised from the published abstract; every number is checked against it