Skeletal muscle adiposity, coronary microvascular dysfunction, and adverse cardiovascular outcomes
Authors' conclusion
Increased intermuscular fat is associated with CMD and adverse cardiovascular outcomes independently of BMI and conventional risk factors. The presence of CMD and SM fat infiltration identified a novel at-risk cardiometabolic phenotype.
Study context
- Population
- Consecutive patients evaluated for CAD with cardiac stress PET showing normal perfusion and preserved LVEF
- Participants
- 669 patients
- Exposure
- Skeletal muscle adiposity and coronary flow reserve (CFR) vs MACE
- Outcome
- MACE (death and hospitalization for MI or HF)
- Follow-up
- Median 6 years
Main finding
As reported in the abstract
MACE
Hazard ratio (95% CI)P value
Lower CFR (per −1 U)adjusted
1.78(1.23–2.58)
P = 0.002Higher IMAT (per +10 cm²)adjusted
1.53(1.30–1.80)
P < 0.0001Higher SM (per +10 cm²)adjusted; protective
.89(.81-.97)
P = 0.01Higher SAT (per +10 cm²)adjusted; protective
.94(.91-.98)
.003Fatty muscle fraction (per 1% increase)adjusted
1.07(1.04–1.09)
P < 0.001Each row per its own increment, as printed
- Significant CFR × IMAT interaction (not body mass index (BMI)); Coronary microvascular dysfunction (CMD) plus fatty muscle had highest MACE risk
- adjusted P = .02
Observational data: associations, not effects.
Further findings
| Outcome | OR (CI) | P value | |
|---|---|---|---|
| CMD (CFR <2) per 1% increase in fatty muscle fractionAdjusted | 1.02 (1.01–1.04) | P = 0.04 | |
| 0.512Odds ratio (log scale) |
Association with decreased CFR
- Decreased skeletal muscle (SM) independently associated with decreased CFR
- adjusted P = .03
- Increased IMAT independently associated with decreased CFR
- P = 0.04
- BMI and subcutaneous adipose tissue (SAT) not independently associated with decreased CFR
Correlation of BMI with SAT, IMAT and SM
- BMI vs SAT
- r = .84
- BMI vs IMAT
- r = .71
- BMI vs SM
- r = .52
- P < .001
Original publication
Skeletal muscle adiposity, coronary microvascular dysfunction, and adverse cardiovascular outcomes. Eur Heart J. Published 20 January 2025. doi:10.
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