Visceral fat index: a novel predictor for coronary collateral circulation.

Yasin Sahinturk,Abdullah Tokuc,Selcuk Kucukseymen,Rauf Avci,Gokhan Koker,Basak Oguz Yolcular,Ayse Akarsu,Sakir Arslan,Nermin Bayar

doi:10.20945/2359-3997000000218

Abstract

Objective This study was designed to investigate the role of visceral adiposity along with other clinical parameters in predicting poor coronary collateral circulation (CCC) among patients with severe obstructive coronary artery disease (CAD). Subjects and methods A total of 135 patients with severe obstructive CAD and good (n = 70) or poor (n = 65) CCC were included. Data on angiographically detected CCC, the quality criteria for CCC (Rentrop scores) and visceral fat index (VFI) obtained via bioelectrical impedance were compared between good and poor CCC groups. Independent predictors of poor CCC, the correlation between VFI and Rentrop score and the role of VFI in the identification of CCC were analyzed. Results A significant negative correlation was noted between VFI and Rentrop scores (r = -0.668, < 0.001). The presence of hypertension (OR 4.244, 95% CI 1.184 to 15.211, p = 0.026) and higher VFI (OR 1.955, 95% CI 1.342 to 2.848, p < 0.001) were shown to be independent predictors of an increased risk for poor CCC. ROC analysis revealed a VFI > 9 (AUC [area under the curve] (95% CI): 0.898 (0.834-0.943), p < 0.0001) to be a potential predictor of poor CCC with a sensitivity of 95.38% and specificity of 85.71%. Conclusion In conclusion, our findings revealed comorbid hypertension and higher VFI to significantly predict the risk of poor CCC in patients with severe obstructive CAD.

Highlights

C oronarycollateralcirculation(CCC)isaphysiological adaptation that serves as a natural bypass system to restore blood flow in myocardium jeopardized by stenosis or the occlusion of a coronary vessel [1,2]
The poor vs. good collateral circulation (CCC) groups were similar in terms of the lipid profile, TG-high-density lipoprotein (HDL)-c ratio and inflammatory markers, including C-reactive protein (CRP), neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-platelet ratio (NPR) (Table 1)
Our findings in a cohort of coronary artery disease (CAD) patients with total coronary occlusion revealed the presence of hypertension and higher visceral fat index (VFI) to be significant determinants of poor CCC development

Summary

INTRODUCTION

C oronarycollateralcirculation(CCC)isaphysiological adaptation that serves as a natural bypass system to restore blood flow in myocardium jeopardized by stenosis or the occlusion of a coronary vessel [1,2]. No studies to date have investigated the potential role of visceral adiposity in coronary collateral development in patients with severe obstructive CAD. Data on patient demographics (age, sex), smoking and alcohol consumption, comorbidities (diabetes, hypertension), concomitant medications, CAD characteristics (type and number of occluded coronary arteries), anthropometrics [body mass index (BMI, kg/m2), muscle mass, fat mass, visceral fat index (VFI)], blood biochemistry [total cholesterol, triglycerides, high-density lipoprotein (HDL), lowdensity lipoprotein (LDL), creatinine], hemogram [neutrophil, lymphocyte, thrombocyte, white blood cell (WBC) counts, hemoglobin] and inflammatory markers [C-reactive protein (CRP), neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR)] were recorded for each patient and compared between the good and poor CCC groups. Variables with a p value < 0.05 in the univariate analysis were analyzed further in a multivariate regression model to identify statistically significant risk factors for poor CCC. Data are expressed as the mean (standard deviation, SD) or median (min-max), as appropriate. p < 0.05 was considered statistically significant

RESULTS

DISCUSSION

Study limitations